An increasing number of sensitized patients awaiting transplantation face limited options, leading to fatalities during dialysis and higher costs. The absence of established evidence highlights the need for collaborative consensus. Donor-specific antibodies (DSA)-triggered antibody-mediated rejection (AMR) significantly contributes to kidney graft failure, especially in sensitized patients. The European Society for Organ Transplantation (ESOT) launched the ENGAGE initiative, categorizing sensitized candidates by AMR risk to improve patient care. A systematic review assessed induction and maintenance regimens as well as antibody removal strategies, with statements subjected to the Delphi methodology. A Likert-scale survey was distributed to 53 European experts (Nephrologists, Transplant surgeons and Immunologists) with experience in kidney transplant recipient care. A rate ≥75% with the same answer was considered consensus. Consensus was achieved in 95.3% of statements. While most recommendations aligned, two statements related to complement inhibitors for AMR prophylaxis lacked consensus. The ENGAGE consensus presents contemporary recommendations for desensitization and immunomodulation strategies, grounded in predefined risk categories. The adoption of tailored, patient-specific measures is anticipated to streamline the care of sensitized recipients undergoing renal allografts. While this approach holds the promise of enhancing transplant accessibility and fostering long-term success in transplantation outcomes, its efficacy will need to be assessed through dedicated studies., Competing Interests: Author LF has participated in advisory board and/or speakers bureau for Novartis Farmacéutica, S.A., Chiesi Farmaceutici S.p.A, Hansa Biopharma, Alexion Pharmaceuticals, Astellas Pharma Inc. Author OB has received consulting fees and research support by Hansa Biophama. Author KB declares honoraria, research grant, and or travel support from: Aicuris, Alexion, Astellas, AstraZeneca, Biohope, Bristol-Myers Squibb, CareDx, Carealytics Digital Health, Chiesi, CSL Behring, DTB GmbH, Eledon, Fresenius, Hansa, HiBio, MSD, Natera, Neovii, Oncocyte, OSKA, Otsuka, Paladin, Pfizer, Pirche, Sanofi, smart Care solutions, Stada, Takeda, Veloxis, Vifor and Xenothera. Author EC has participated in advisory boards or acted as a consultant for Novartis, Astellas, Hansa Biopharma and eGenesis. Author FD has received speaker honoraria from Hansa Biopharma. His institution is receiving research funds from Hansa Biopharma for an investigator-initiated clinical trial. Author NM has done consultancy work with Hansa Biophama. Author SSS has participated in advisory board for Hansa Biopharma. Author OT has participated in advisory board and/or speakers bureau for Adocia, Biotest and Chiesi Farmaceutici S.p.A. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Furian, Bestard, Budde, Cozzi, Diekmann, Mamode, Naesens, Pengel, Schwartz Sorensen, Vistoli and Thaunat.)