imlifidase at a glance
Medicine class
IgG-cleaving immunosuppressant enzyme
Licensed role
Desensitisation before deceased-donor kidney transplantation in selected highly sensitised adults with a positive crossmatch
Administration
Intravenous infusion given in hospital by a specialist transplant team
Important limitation
It does not replace usual transplant immunosuppressive treatment
What is imlifidase used for?
Imlifidase is licensed for highly sensitised adults awaiting a kidney from an available deceased donor when crossmatching is positive and transplantation through the usual allocation system is unlikely.
It temporarily reduces donor-specific IgG antibodies so crossmatch conversion can be confirmed before transplantation.
Use is restricted to specialist kidney-transplant services and carefully selected patients.
How does imlifidase work?
Imlifidase cuts the heavy chains of every human IgG subclass, removing antibody functions that can damage a donor kidney. Its effect is temporary: IgG and donor-specific antibodies can return, so rejection monitoring remains essential.
imlifidase preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 11 mg
How to take imlifidase
Imlifidase is not taken at home. A transplant specialist prescribes it, and trained staff prepare and give it through a vein in hospital.
Crossmatch conversion from positive to negative must be confirmed before transplantation.
Medicines are given beforehand to reduce infusion-reaction risk.
The transplant team arranges infection prevention and other required immunosuppressive treatment.
imlifidase side effects
Common or expected effects
- Bacterial or viral infections, including respiratory or urinary infections
- Infusion reactions, flushing, feeling hot or infusion-site pain
- Headache, muscle pain or dizziness on standing
- Rash or shortness of breath
- Changes in blood pressure or heart rate
- Raised liver enzymes
- Antibody-mediated transplant rejection
Get urgent medical advice
- Severe allergic or anaphylactic reaction, including breathing difficulty, severe rash or collapse
- Serious infection, including pneumonia or sepsis
- Antibody-mediated rejection, which may cause graft dysfunction or general illness
imlifidase in pregnancy
Human pregnancy data are unavailable. UK product information advises avoiding imlifidase during pregnancy; tell the transplant team promptly if you may be pregnant.
imlifidase while breastfeeding
It is unknown whether imlifidase enters human milk, and risk to a breastfed child cannot be excluded. Breastfeeding should be stopped before exposure, with advice from the transplant and maternity teams.
imlifidase interactions
Imlifidase cleaves human and rabbit IgG, so the transplant team must carefully sequence antibody-based treatments.
Intravenous immunoglobulin (IVIg)
Imlifidase can cleave IVIg, while previously administered IVIg may contain antibodies that neutralise imlifidase.
Basiliximab, rituximab and alemtuzumab
These IgG-based antibodies may be inactivated if given too close to imlifidase.
Adalimumab, denosumab and etanercept
Imlifidase may cleave these antibody-based treatments and reduce their activity.
Common questions about imlifidase
Answers are fully visible for fast scanning and source review.
Does imlifidase permanently remove antibodies?
No. Its effect is temporary, and donor-specific antibodies may return after transplantation.
Can the kidney still be rejected?
Yes. Antibody-mediated rejection can occur as antibodies return, so close specialist monitoring and usual transplant immunosuppression remain necessary.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.