Imlifidase for the treatment of anti-HLA antibody-mediated processes in kidney transplantation

Am J Transplant. 2022 Mar;22(3):691-697 doi: 10.1111/ajt.16828.

The IgG-degrading enzyme derived from Streptococcus pyogenes (Imlifidase, Hansa Biopharma) is a novel agent that cleaves all four human subclasses of IgG and has therapeutic potential for HLA desensitization in kidney transplantation and antibody-mediated rejection. Data from clinical trials in kidney transplantation demonstrated rapid degradation of anti-HLA donor-specific antibodies facilitating HLA-incompatible transplantation, which led to conditional approval of imlifidase by the European Medicines Agency for desensitization in kidney transplant recipients of a deceased donor with a positive cross match. Important considerations arising from the early experiences with imilfidase on kinetics of donor-specific antibodies after administration, timing of complementary therapeutic monoclonal or polyclonal IgG antibodies, and interference with cross match assays should be recognized as imlifidase emerges as a therapeutic agent for clinical transplantation.

LEVEL OF EVIDENCE: Case Series / Case Control / Cohort
KEYWORDS: alloantibody; clinical research; desensitization; immune modulation; immunosuppressant - other; immunosuppression; kidney transplantation; nephrology; practice; rejection: antibody-mediated (ABMR); sensitization
MESH HEADINGS: Antilymphocyte Serum; Graft Rejection; HLA Antigens; Humans; Immunoglobulin G; Immunosuppressive Agents; Kidney Transplantation; Tissue Donors