One-year outcomes following imlifidase-enabled kidney transplantation in highly sensitized recipients: First Belgian...

Imlifidase, an IgG-cleaving enzyme, offers a novel desensitization strategy for highly sensitized kidney-transplant candidates with donor-specific antibodies (DSA). We report the first Belgian kidney recipient with a positive virtual crossmatch and treated with a single dose of imlifidase prior to transplantation. HLA antibodies were assessed using complement dependent cytotoxicity (CDC) and Luminex single-antigen bead (SAB) assays (Werfen®) before treatment, 4 h post-injection, and at regular intervals following the Belgian imlifidase protocol. The injection led to rapid extinction of DSA, with a rebound during the first weeks. Early outcomes showed immediate graft function without surgical complications. DSA reappeared within days but stabilized at around 500 MFI levels to date. A subclinical rejection on day 14 was treated successfully. Serum creatinine remained stable, with no severe adverse events. These outcomes suggest that imlifidase, combined with the intensified immunosuppression, can provide effective DSA reduction while maintaining graft stability over one year.