Imlifidase for desensitisation treatment before kidney transplant in people with chronic kidney disease

Imlifidase

• is an IgG-degrading enzyme derived from Streptococcus pyogenes
• 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
• is a recombinant cysteine protease derived from S. pyogenes produced recombinantly in Escherichia coli which has the capacity to cleave all four human subclasses of IgG with precise specificity (1)

NICE guidance (2):

Imlifidase is recommended as a desensitisation treatment option for adults who:

• are waiting for a kidney transplant from a deceased donor
• are highly sensitised to human leukocyte antigens (HLA)
• have a positive crossmatch with the donor and are unlikely to have a transplant under the available kidney allocation system (including prioritisation programmes for highly sensitised people)

It is recommended only if:

• a maximum of 1 dose is given
• it is given in a specialist centre with experience of treating high sensitisation to HLA
• the company provides imlifidase according to the commercial arrangement

Reference:

• Huang E, Maldonado AQ, Kjellman C, Jordan SC. Imlifidase for the treatment of anti-HLA antibody-mediated processes in kidney transplantation. Am J Transplant. 2022 Mar;22(3):691-697.
• NICE (July 2022). Imlifidase for desensitisation treatment before kidney transplant in people with chronic kidney disease