Belgian Consensus Guidelines Within Eurotransplant on Imlifidase-enabled Deceased Donor Kidney Transplantation in Highly Sensitized Patients
A Belgian expert group within the Eurotransplant network has issued consensus guidelines for imlifidase-enabled deceased-donor kidney transplantation in highly sensitized patients, defining eligibility and post-transplant management for a population with otherwise minimal chance of receiving a compatible organ.
Background
Highly sensitized kidney transplant candidates—typically those with panel-reactive antibody levels above 85%—have a low probability of receiving a compatible organ. Within Eurotransplant, an international allocation network serving eight European countries, the prioritized 'acceptable mismatch' program improves access, but some highly sensitized patients still cannot be matched to a donor.
Key recommendations
For patients who remain in the acceptable-mismatch program for three or more years without transplantation, the guidelines incorporate imlifidase—an IgG-cleaving enzyme that rapidly degrades antibodies—as a desensitization option. The consensus defines patient eligibility criteria aligned with Eurotransplant allocation rules and sets out post-transplant management strategies for these high-risk recipients. The guidelines are designed as a model that any center in the Eurotransplant region could adapt.
Clinical implications
The framework gives Eurotransplant-region centers a practical, harmonized approach to integrating imlifidase desensitization into real-world care for hard-to-match candidates. The authors stress that the guidelines are dynamic and will be reviewed and updated as Eurotransplant allocation rules evolve and clinical experience with imlifidase accumulates.
Category
Transplant
Source
Transplantation
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