Inclusion Criteria:  Signed Informed Consent obtained before any trial-related procedures Male or female age 18-70 years at the time of screening Chronic kidney disease (CKD) stage 5, highly sensitized as evaluated by standard selection criteria, and active on the OPTN waiting list for a DD kidney transplant Original calculated panel reactive antibody (cPRA) ≥99.9% Virtual crossmatch (vXM), predictive of a positive crossmatch to an available deceased donor (DD) Willingness and ability to comply with the protocol Willingness to participate in the planned 4-year extension trial  Exclusion Criteria:  High dose IVIg (2 g/kg) treatment within 28 days prior to imlifidase treatment Previous treatment with imlifidase Breast feeding or pregnancy Women of child-bearing potential not willing or able to practice FDA-approved forms of contraception, or abstinence. Two medically acceptable methods of highly effective contraception must be used for the duration of the study (e.g. oral, transdermal, intravaginal, injectable or implantable contraceptive; intrauterine device; intrauterine hormone-releasing system; vasectomized partner; bilateral tubal occlusion; or double barrier method). For a woman to be considered postmenopausal this ascertainment must be made according to medical records and clinical history and may be aided by measurement of elevated postmenopausal serum gonadotropin levels (FSH). ABO blood group incompatible transplantations (A2 or A2B kidneys will not be accepted for B recipients) Positive serology for human immunodeficiency virus (HIV) Clinical signs of hepatitis B virus (HBV) or hepatitis C virus (HCV) infections Clinical signs of cytomegalovirus (CMV) or Epstein-Barr virus (EBV) infections Positive test for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) (according to local hospital routines) Active tuberculosis Severe other conditions requiring treatment and close monitoring, e.g. cardiac failure ≥grade 4 (New York Heart Association), unstable coronary disease or oxygen dependent chronic obstructive pulmonary disease (COPD) Any condition that in the view of the Investigator precludes transplantation History of a proven hypercoagulable condition Present or history of thrombotic thrombocytopenic purpura (TTP), or known familial history of TTP Intake of investigational drugs within 5 half-lives of the drug or 3 months, whichever is the longest Contemporaneous participation in a medical device study Known mental incapacity or language barriers precluding 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