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Kidney Transplantation in Highly Sensitized PatientsPhase 2DINKYNCT05753930

Imlifidase Prior to Kidney Transplant in Highly Sensitised Children

A Phase 2 study testing Imlifidase in people with Kidney Transplantation in Highly Sensitized Patients, run by Hansa Biopharma AB at 6 sites in 5 countries.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to learn about the efficacy and safety of imlifidase in highly sensitized paediatric patients, 1-17 years old, with end stage renal disease (ESRD). Read more about this study

Who is it for?
Ages 1 year to 17 years
What is being tested?
Imlifidase
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
10 participants
Where
6 sitesin 5 countries
Study dates
2 Jun 2023to 31 Aug 2031
Phase
Phase 2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 year to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Signed Informed Consent obtained from patient/parent/legal guardian/independent witness (depending on patient's age) before any trial-related procedures
  • Highly sensitised patient with panel reactive antibodies (PRA) ≥80%
  • Male or female patient between the age of 1 to 17 years (up to the day before the 18th birthday) at the time of screening
  • Patient with end-stage renal disease (ESRD) and waiting for a renal transplant from a living or deceased donor
  • Patient must be transplantable (including size mismatch) at the time of obtaining informed consent for trial participation
  • Patients who have previously undergone desensitisation unsuccessfully with plasmapheresis/IVIg/anti-CD20 or have an anti-HLA antibody status deemed too difficult to make a successful desensitisation (judgement based on physicians' previous experience with similar patients)
  • Positive crossmatch (XM) test determined by flow cytometry crossmatch (FCXM) and/or complement-dependent cytotoxicity crossmatch (CDCXM) tests against the donor. For the DD patients, if physical XM tests are not practically possible due to lack of time, patients may be included on a virtual crossmatch (vXM) predictive of a positive XM test.
  • Willingness and ability to comply with the protocol as judged by the investigator

Who cannot join

  • Previous treatment with imlifidase
  • IVIg treatment within 28 days prior to imlifidase treatment
  • Desensitisation treatment(s) within 1 month prior to the current transplantation
  • Hypersensitivity to the active substance (imlifidase) or to any of the excipients and to other immunosuppressive drugs specified in the protocol
  • Ongoing serious infections
  • Present, or history of, thrombotic thrombocytopenic purpura (TTP), or known familial history of TTP
Show all 22Show fewer
  • At the time of transplantation: severe other condition requiring treatment and close monitoring e.g. cardiac failure ≥ grade 4 (New York Heart Association), unstable coronary disease, active peripheral vascular disease, proven hypercoagulable conditions/events or oxygen dependent respiratory disease
  • Malignancy within 3 years prior to transplantation
  • ABO blood group incompatible transplantations (A2 and A2B kidneys will not be accepted for B recipients)
  • Any other reason that, in the view of the investigator, precludes transplantation
  • Breast feeding or pregnancy, if applicable
  • Woman of fertile age and sexually active without adequate contraceptive measures to avoid pregnancy during the interventional trial period (i.e. up to 6 months after transplantation)
  • Suspicion of Covid-19 infection or positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test
  • Positive serology for human immunodeficiency virus (HIV)
  • Clinical signs of hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV), or Epstein Barr virus (EBV) infection
  • Donor with positive serology for HIV, HBV, HCV or CMV to a patient with negative serology (mismatch serology). Mismatch serology for EBV in accordance with center specific standard procedures for transplantation of EBV negative recipients and at investigator's discretion.
  • Clinically relevant active infection(s) as judged by the investigator
  • Tuberculosis or history of tuberculosis
  • Use of other investigational agents within 5 terminal elimination half-lives prior to the transplantation
  • Contemporaneous participation in medical device studies
  • Known mental incapacity or language barriers precluding patients'/parents'/legal guardians' adequate understanding of the informed consent information and the trial activities
  • Inability by the judgement of the investigator to participate in the trial for any other reason

Trial locations and contacts

6 sites in 5 countries. Contact the study team or a site near you to ask about taking part.

6 sites in 5 countries

Spain2 sites, 2 recruiting
  • Hospital Unviersitari Vall d'Hebron, Nefrología Pediátrica

    Barcelona, 08035

    Gema Ariceta, MD, gema.ariceta@vallhebron.cat

    Gema Ariceta, MD

    Recruiting
  • Hospital Sant Joan De Deu Barcelona

    Barcelona, 08950

    Yolanda Calzada, MD, frecerca.startup@sjd.es

    Yolanda Calzada, MD

    Not yet recruiting

Other trials in Spain

Finland1 site
  • HUS, Helsinki University Hospital

    Helsinki, 00290

    Withdrawn

Other trials in Finland

France1 site, 1 recruiting
  • Robert Debre University Hospital

    Paris, 75019

    Julien Hogan, Professor, julien.hogan2@aphp.fr

    Julien Hogan, Professor

    Recruiting

Other trials in France

Sweden1 site, 1 recruiting
  • Karolinska University Hospital

    Huddinge, Stockholm County, SE-141 86

    L Wennberg, MD, Lars.Wennberg@regionstockholm.se

    L Wennberg, MD

    Recruiting

Other trials in Sweden

United Kingdom1 site, 1 recruiting
  • Great Ormond Street Hospital for Children NHS Foundation Trust

    London, WC1N 3JH

    S Marks, MD

    S Marks, MD

    Recruiting

Other trials in United Kingdom

About this study

Official title: A Single-arm, Multi-centre Trial to Evaluate Efficacy and Safety of Imlifidase in Highly Sensitised Children (1-17 Years) Receiving a Kidney Transplant With Positive Crossmatch Against a Living or Deceased Donor Converted to Negative After Imlifidase Treatment

The goal of this clinical trial is to learn about the efficacy and safety of imlifidase in highly sensitized paediatric patients, 1-17 years old, with end stage renal disease (ESRD).

The main questions it aims to answer are:

  • Does imlifidase treatment result in crossmatch conversion that enables transplantation?
  • How is the function of the transplanted kidney?

The participants will be hospitalised in accordance with the normal routines for transplanted patients. The patients will receive medication to prevent rejection of the donor kidney, and because such treatment make the body more vulnerable medications to prevent infections.

Read the detailed description

After being informed about the study and potential risks, all patients giving written informed consent will undergo pre-screening to determine eligibility for study entry.

The trial will include highly sensitised ESRD paediatric patients (1-17 years). The patients have previously undergone desensitization unsuccessfully or have an anti-HLA antibody status deemed too difficult to make a successful desensitization using other experimental methods.

A screening visit will take place when an organ offer has been placed for a final check of the patients' eligibility for study participation.

All patients included in the trial will be desensitized with imlifidase to convert the positive XM to negative and then transplanted with either a kidney from a deceased donor (DD) or a living donor (LD).

Patients will be hospitalised in accordance with the normal routines for transplanted patients at each clinic.

Following transplantation, the patients will receive induction therapies, rejection prophylaxis, and maintenance immunosuppressive therapies.

The patients will be closely monitored for any signs of antibody-mediated rejections (AMRs).

The duration of the interventional trial period after an organ has been offered will be 6 months for each patient. The trial includes a follow-up part to collect long-term efficacy and safety data up to 5 years after the transplantation.

Being tested
Imlifidase
Keywords
Desensitization, Highly sensitized, Positive crossmatch, Unlikely to be transplanted, Kidney transplantation, Deceased donor, Living donor, End-Stage Renal Disease, Paediatric patients, Children, Incompatible transplant
Medical subject headings
Kidney Failure, Chronic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ImlifidaseDrug

    Also called IdeS, HMED-IdeS

    Imlifidase is an immunoglobulin G (IgG)-degrading enzyme of Streptococcus pyogenes that is highly selective towards IgG. The cleavage of IgG generates one F(ab')2- and one homodimeric Fc-fragment and efficiently neutralizes Fc-mediated activities of IgG.

Study groups in NCT05753930
Study groupRoleWhat they receive
ImlifidaseExperimentalImlifidase is administered intravenously as one infusion of 0.25 mg/kg over 15 minutes within 24 hours prior to transplantation.
Receives: Drug: Imlifidase

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of patients with conversion of a positive crossmatch test to negative within 24 hours after start of imlifidase treatment

    Immunoglobulins (IgG) including donor specific antibodies (DSAs) are rapidly and efficiently cleaved by imlifidase. A conversion of a positive to a negative XM will enable transplantation.

    Measured: From start of imlifidase administration to 24 hours

Secondary outcomes (21)
  1. Renal function up to 5 years after transplantation as assessed by estimated glomerular filtration rate (eGFR)

    eGFR is a measure of kidney function. Reduced kidney function is characterised by a decreased eGFR value.

    Measured: From pre-dose imlifidase up to 5 years

  2. Renal function up to 5 years after transplantation as assessed by serum/plasma creatinine levels

    Creatinine is a measure of kidney function. Reduced kidney function is characterised by an increased value.

    Measured: From pre-dose imlifidase up to 5 years

  3. Renal function up to 5 years after transplantation as assessed by serum/plasma cystatin C levels

    Cystatin C is a measure of kidney function. Reduced kidney function is characterised by an increased value.

    Measured: From pre-dose imlifidase up to 5 years

  4. Renal function up to 5 years after transplantation as assessed by proteinuria

    Proteinuria (protein/creatinine ratio in urine) is a measure of kidney function. Reduced kidney function is characterised by an increased value.

    Measured: From pre-dose imlifidase up to 5 years

  5. DSA levels up to 5 years after transplantation

    Donor specific antibodies (DSAs) are antibodies in the recipient directed against the transplanted organ.

    Measured: From pre-dose imlifidase up to 5 years

  6. Graft survival (death censored) up to 5 year after transplantation

    Measured: From 6 months up to 5 years

  7. Graft failure-free survival up to 5 years after transplantation

    Measured: From 6 months up to 5 years

  8. Patient survival up to 5 years after transplantation

    Measured: From 6 months up to 5 years

  9. Frequency of delayed graft function (DGF)

    DGF is defined as 'Need for dialysis within 7 days of transplantation' in "Delayed graft function in kidney transplantation: developing drugs for prevention, guidance for industry", FDA 2019.

    Frequency of patients having DGF in accordance with this definition will be presented.

    Measured: From transplantation up 7 days after transplantation

  10. Length of DGF

    DGF is defined as 'Need for dialysis within 7 days of transplantation' in "Delayed graft function in kidney transplantation: developing drugs for prevention, guidance for industry", FDA 2019.

    The duration of DGFs in accordance with this definition will be presented.

    Measured: From transplantation up 7 days after transplantation

  11. Proportion of patients with dialysis dependency up to 5 years after transplantation

    Measured: From 6 months up to 5 years

  12. Imlifidase Pharmacokinetics (AUC)

    AUC = Area under the imlifidase plasma concentration versus time curve.

    Measured: From pre-dose imlifidase up to Day 15

  13. Imlifidase Pharmacokinetics (Cmax)

    Cmax = Maximum observed plasma concentration of imlifidase following dosing.

    Measured: From pre-dose imlifidase up to Day 15

  14. Imlifidase Pharmacokinetics (tmax)

    tmax = Time point for maximum observed plasma concentration of imlifidase following dosing

    Measured: From pre-dose imlifidase up to Day 15

  15. Imlifidase Pharmacokinetics (t1/2)

    t1/2 = Terminal half-life of imlifidase.

    Measured: From pre-dose imlifidase up to Day 15

  16. Imlifidase Pharmacokinetics (CL)

    CL = Clearance of imlifidase.

    Measured: From pre-dose imlifidase up to Day 15

  17. Imlifidase Pharmacokinetics (Vz)

    Vz = Volume of distribution during the elimination phase

    Measured: From pre-dose imlifidase up to Day 15

  18. Imlifidase Pharmacodynamic (PD) profile up to 9 days after imlifidase treatment

    PD is assessed as serum concentrations of intact IgG and its fractions following infusion.

    Measured: From pre-dose imlifidase up to Day 10

  19. Immunogenicity profile of imlifidase up to 5 years after imlifidase treatment

    Immunogenicity is assessed as serum concentration of anti-imlifidase IgG (ADA).

    Measured: From pre-dose imlifidase up to 5 years

  20. Proportion of patients with biopsy- and serology (DSA)-confirmed AMR up to 5 years after transplantation

    Banff scores (Loupy et al. 2020) will be used for biopsy evaluation.

    Measured: From transplantation up to 5 years

  21. Proportion of patients with biopsy confirmed cell-mediated rejection (CMR) up to 5 years after transplantation

    Banff scores (Loupy et al. 2020) will be used for biopsy evaluation.

    Measured: From transplantation up to 5 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Mar 2023
  2. Study start2 Jun 2023
  3. Primary completion28 Feb 2027 (estimated)
  4. Study completion31 Aug 2031 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
This is an open-label, non-randomised trial in highly sensitized paediatric kidney transplant patients with positive XM against an available DD or LD. The rationale for a non-randomised trial in DD kidney transplantation is that there are no other effective or approved desensitisation protocols that would provide a suitable or ethical control. The rationale for a non-randomised trial in LD kidney transplantation is that potential control treatments have already been tried unsuccessfully in the patients or such treatments are judged as highly unlikely to succeed based on the breadth and depth of the patients' sensitisation. Treatment with little anticipation of success would expose the patients to unnecessary immunosuppression.
Masking
None (open label)
Enrolment
10 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05753930
Sponsor's protocol ID
20-HMedIdes-21
Other IDs
2022-500230-28-00
Acronym
DINKY
Status last verified
Apr 2026
First submitted
23 Feb 2023
Last updated
18 Aug 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Loupy A, Haas M, Roufosse C, Naesens M, Adam B, Afrouzian M, Akalin E, Alachkar N, Bagnasco S, Becker JU, Cornell LD, Clahsen-van Groningen MC, Demetris AJ, Dragun D, Duong van Huyen JP, Farris AB, Fogo AB, Gibson IW, Glotz D, Gueguen J, Kikic Z, Kozakowski N, Kraus E, Lefaucheur C, Liapis H, Mannon RB, Montgomery RA, Nankivell BJ, Nickeleit V, Nickerson P, Rabant M, Racusen L, Randhawa P, Robin B, Rosales IA, Sapir-Pichhadze R, Schinstock CA, Seron D, Singh HK, Smith RN, Stegall MD, Zeevi A, Solez K, Colvin RB, Mengel M. The Banff 2019 Kidney Meeting Report (I): Updates on and clarification of criteria for T cell- and antibody-mediated rejection. Am J Transplant. 2020 Sep;20(9):2318-2331. doi: 10.1111/ajt.15898. Epub 2020 May 28.

    PubMed 32463180

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Imlifidase in people with Kidney Transplantation in Highly Sensitized Patients, run by Hansa Biopharma AB at 6 sites in 5 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 22 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 18 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in Spain, Finland, France, Sweden, United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Central Contact (+46 46 16 56 70, clinicalstudyinfo@hansabiopharma.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of patients with conversion of a positive crossmatch test to negative within 24 hours after start of imlifidase treatment (time frame: From start of imlifidase administration to 24 hours). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05753930, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Aug 2026.

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