Highly sensitised patients represent one of the most challenging populations in kidney transplantation, facing prolonged waiting times, reduced access to compatible organs, and lower transplant rates even under conventional desensitisation methods. For many, transplantation remains difficult to achieve. Idefirix® (imlifidase) is an IgG-inactivating therapy based on a cysteine protease originating from Streptococcus pyogenes. Idefirix converts a positive crossmatch to negative within hours and enabling transplantation across immunological barriers that would otherwise preclude it. This symposium brings together international and Australian transplant clinicians to review the current evidence base for Idefirix in highly sensitised kidney transplantation. Presentations will cover long-term efficacy and safety outcomes from controlled clinical studies, real-world experience, and early Australian practice, across both deceased and living donor settings. Together, the faculty will move from evidence to bedside, distilling how this expanding body of data is reshaping the way clinicians identify, transplant, and care for patients once considered untransplantable.