Imlifidase in Highly Sensitized Kidney Transplant Recipients With a Positive Crossmatch Against a Deceased Donor

• DOI: 10.1016/j.ekir.2024.07.024
• Publication Date: 2024-07-30T16:35:17Z
• Authors: Nassim Kamar; Dominique Bertrand; Sophie Caillard; Danièle Pievani; Marie Joelle Apithy; Nicolas Congy-Jol...; Bertrand Chauveau; Fabienne Farce; Arnaud François; Audrey Delas; Jérôme Olagne; Cédric Usureau; Jean-Luc Taupin; Gwenda Line Guidi...; Lionel Couzi
• Keywords: Kidney transplantation; Positive crossmatch; [SDV.IMM] Life Sciences [q-bio]/Immunology; Clinical Research; 616; [SDV.IMM]Life Sciences [q-bio]/Immunology; 610; Highly sensitized patients; Imlifidase

IntroductionImlifidase is authorized for desensitization of highly sensitized adult kidney transplant candidates with a positive crossmatch (XM) against deceased donor. Here, we report on the results first 9 patients transplanted in this context who had at least 3 months follow-up.MethodsThe eligibility criteria were as follows: calculated panel reactive antibodies (cPRA) ³ 98%, years waiting list, immunodominant donor-specific (DSAs) mean fluorescence intensity (MFI) > 6000 (and < 5000 1:10 dilution) and negative post-imlifidase complement-dependent cytotoxic XM (CDCXM).ResultsAll been dialysis an average 123 ± 41 months, cPRA 99% (n = 2) or 100% 7). At transplantation, number DSAs was 4.3 1.4. The median DSA MFI 9153 (6430–16,980). Flow cytometry (FCXM) CDCXM before imlifidase 2 patients, respectively. After 1 injection imlifidase, all negative. Patients received polyclonal antibodies, i.v. Igs (IVIg), rituximab, tacrolimus, mycophenolate. Five rebound within 14 days: concomitant clinical antibody-mediated rejection (ABMR), subclinical ABMR, isolated C4d staining. No ABMR observed without rebound. Chronic Kidney Disease-Epidemiology Collaboration formula estimated glomerular filtration rate (eGFR) 56 22 ml/min per 1.73 m2 last follow-up (7 2.8 months). graft loss death observed. Four developed infection.ConclusionThese real-life data demonstrate that use to desensitize can have acceptable short-term efficacy safety profile selected patients.