Authors
Stefan Reuter, Louise Benning, Andrea Dick, Lisa-Marie Dilz, Gunilla Einecke, Florian Emmerich, Florian Grahammer, Rebecca Großmann, Wilfried Gwinner, Fabian Halleck, Michael Hallensleben, Falko M Heinemann, Bernd Jänigen, Dennis Kannenkeril, Teresa Kauke, Reinhard Kelsch, Stephan Kemmner, Malte Andreas Kluger, Jan Kowald, Andreas Kribben, Claudia Lehmann, Monika Lindemann, Giancarlo Maccagno, Christian Morath, Anja Mühlfeld, Lien Pham, Lutz Renders, Stefan Schaub, Sabine Scherer, Christian Seidl, Bernd Spriewald, Dirk Stippel, Julian Stumpf, Thuong Hien Tran, Rolf Weimer, Benjamin Wilde, Daniel Zecher, Malte Ziemann, Svitlana Ziganshyna, Nils Lachmann, Klemens Budde
Published in
Frontiers in immunology. Volume 17. Pages 1846251. Epub Jun 09, 2026.
Abstract
Kidney transplantation is the preferred treatment for suitable patients with end-stage renal disease; however, access to transplantation declines dramatically with increasing HLA sensitization. While the acceptable mismatch (AM) program by Eurotransplant improves transplantability for highly sensitized candidates, a clinically relevant subgroup with extremely low donor frequency or ineligible for AM remains disadvantaged. In carefully selected cases, the controlled delisting of unacceptable HLA antigens and the use of peri-transplant desensitization (e.g., imlifidase) may enable transplantation. In order to provide better guidance, this German expert consensus report was compiled by the Kidney and Immunology Commissions of the German Transplantation Society and the Organ Transplantation Commission of the German Society for Immunogenetics. Within the German legal framework of urgency and chances for success, the report proposes a practical guide for candidate selection, multidisciplinary governance, risk-adapted HLA delisting, assessment of organ offers, use of imlifidase, perioperative immunosuppression, prophylaxis for infection, post-transplant monitoring, and management of antibody-mediated rejection. These recommendations are intended for experienced transplant centers and aim to balance transplant opportunity against immunological risk in highly sensitized kidney transplant candidates. The primary scope of this article is highly sensitized adult wait-listed candidates considered for deceased-donor kidney transplantation after compatibility-preserving pathways have been exhausted or are unlikely to succeed; HLA-incompatible living-donor transplantation with imlifidase is addressed separately as a potential off-label scenario for selected highly sensitized patients.
PMID:
42344929
Bibliographic data and abstract were imported from PubMed on 25 Jun 2026.
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