Belgian Consensus Guidelines Within Eurotransplant on Imlifidase-enabled Deceased Donor Kidney Transplantation in Highly Sensitized Patients

Transplantation, vol. 109, pp. 1274–1283

Abstract

Highly sensitized (HS) kidney transplant (KTx) candidates, that is, typically considered internationally as those with panel-reactive antibody levels of >85%, remain a substantial subpopulation of patients with low chance of receiving a compatible organ. Among its many objectives, Eurotransplant-an international transplant organ allocation network serving 8 European countries-aims to improve the management of HS KTx candidates through its prioritized "acceptable mismatch" (AM) program. However, despite this program, some HS patients within the Eurotransplant network who have panel-reactive antibodies >85% still cannot access donor kidneys. For patients who remain in the AM program for ≥3 y without undergoing transplantation, an additional prioritization strategy has been implemented. This involves defining further AMs to allow for desensitization with imlifidase within the AM program. While the AM desensitization program was being developed, the Belgian Imlifidase Scientific Expert Group within the Eurotransplant network independently recognized the need for guidelines on imlifidase desensitization for real-world use in HS KTx candidates (including both AM and Eurotransplant Kidney Allocation System patients). This article describes the consensus guidelines they subsequently developed, which represent a model that any center within the Eurotransplant region could adapt or apply in clinical practice when treating HS KTx candidates who require imlifidase desensitization. The consensus guidelines include patient eligibility criteria for imlifidase treatment that align with Eurotransplant allocation rules and incorporate posttransplant management strategies for HS patients. These guidelines are dynamic and will be reviewed and updated regularly as Eurotransplant rules change and imlifidase experience grows.

Authors 21

1. Dirk R. J. Kuypers corresponding

   Universitair Ziekenhuis Leuven

   Affiliation as printed

   Department of Microbiology, Immunology and Transplantation, University Hospitals Leuven, Belgium

   Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Belgium

2. Frans H. J. Claas Aachen

   Leiden University Medical Center · Antwerp University Hospital

   Affiliation as printed

   Leiden University Medical Center, Leiden, the Netherlands

   University Hospitals Antwerpen, Antwerp, Belgium

3. Antoine Bouquegneau

   University of Liège · Centre Hospitalier Universitaire de Liège

   Affiliation as printed

   Division of Nephrology-Dialysis and Transplantation, University of Liège, CHU Sart-Tilman, Liège, Belgium

4. Antoine Buémi

   Cliniques Universitaires Saint-Luc

   Affiliation as printed

   University Clinic Saint-Luc, Brussels, Belgium

5. Johan Willem de Fijter

   Antwerp University Hospital

   Affiliation as printed

   University Hospitals Antwerpen, Antwerp, Belgium

6. Marie‐Paule Emonds
   Affiliation as printed

   Red Cross-Flanders, Mechelen, Brussels

7. Giuseppe Gambino

   Universitair Ziekenhuis Brussel

   Affiliation as printed

   University Hospitals Brussels, Belgium

8. Thibaut Gervais

   Cliniques Universitaires Saint-Luc

   Affiliation as printed

   University Clinic Saint-Luc, Brussels, Belgium

9. André Gothot

   University of Liège · Centre Hospitalier Universitaire de Liège

   Affiliation as printed

   Division of Nephrology-Dialysis and Transplantation, University of Liège, CHU Sart-Tilman, Liège, Belgium

10. Vanda Holovská

    Universitair Ziekenhuis Brussel

    Affiliation as printed

    University Hospitals Brussels, Belgium

11. Alaín Le Moine

    Universitair Ziekenhuis Brussel

    Affiliation as printed

    University Hospitals Brussels, Belgium

12. Annick Massart

    Antwerp University Hospital

    Affiliation as printed

    University Hospitals Antwerpen, Antwerp, Belgium

13. Dimitri Mikhalski

    Universitair Ziekenhuis Brussel

    Affiliation as printed

    University Hospitals Brussels, Belgium

14. Maarten Naesens

    Universitair Ziekenhuis Leuven

    Affiliation as printed

    Department of Microbiology, Immunology and Transplantation, University Hospitals Leuven, Belgium

15. Lissa Pipeleers

    Universitair Ziekenhuis Brussel

    Affiliation as printed

    University Hospitals Brussels, Belgium

16. Justine Schmitt

    University of Liège · Centre Hospitalier Universitaire de Liège

    Affiliation as printed

    Division of Nephrology-Dialysis and Transplantation, University of Liège, CHU Sart-Tilman, Liège, Belgium

17. Corentin Streel

    Cliniques Universitaires Saint-Luc

    Affiliation as printed

    University Clinic Saint-Luc, Brussels, Belgium

18. Steven Van Laecke

    Ghent University Hospital

    Affiliation as printed

    University Hospital Gent, Gent, Belgium

19. Laurent E. Weekers

    University of Liège · Centre Hospitalier Universitaire de Liège

    Affiliation as printed

    Division of Nephrology-Dialysis and Transplantation, University of Liège, CHU Sart-Tilman, Liège, Belgium

20. Karl Martin Wissing

    Universitair Ziekenhuis Brussel

    Affiliation as printed

    University Hospitals Brussels, Belgium

21. Nada Kanaan

    Cliniques Universitaires Saint-Luc

    Affiliation as printed

    University Clinic Saint-Luc, Brussels, Belgium