To propose a comprehensive management framework for highly sensitized kidney transplant candidates that prioritizes compatibility and addresses the significant barriers they face due to anti-HLA sensitization.
Approach:
Imlifidase Use: Imlifidase is highlighted as a rapid access-enabling strategy in specific deceased-donor settings, though its use is associated with a high frequency of antibody-mediated rejection, necessitating careful candidate selection and monitoring.
Key Findings:
The Eurotransplant acceptable mismatch program demonstrates the effectiveness of combining expert-defined acceptable antigens with allocation priority, resulting in high offer and transplant rates for highly sensitized candidates.
Interpretation:
The management of highly sensitized kidney transplant candidates requires a multifaceted approach that integrates immunologic precision, allocation design, and structured monitoring.
Limitations:
The review does not provide a universally accepted definition of highly sensitized candidates, which may impact the consistency of management strategies.
Conclusion:
A compatibility-first strategy is essential for improving access to transplantation for highly sensitized kidney transplant candidates.
