Immunological Reset to Enable Access to Hla-compatible Kidney Transplantation in Highly Sensitized Patients (RESET)

Inclusion Criteria: * Patients aged between 18 and 60 years. * Diagnosis of end-stage kidney disease (ESRD) currently maintained on chronic dialysis. * Highly sensitized/hyperimmunized status, defined by a high calculated Panel Reactive Antibody (cPRA) level (e.g., \>= 95%). * Active status on the deceased-donor kidney transplant waiting list. * Adequate bone marrow, hepatic, cardiac, and pulmonary function to safely undergo the conditioning regimen and AHSCT. * Capable of understanding the study requirements and providing written informed consent. Exclusion Criteria: * Contraindications to the conditioning regimen medications (rituximab, cyclophosphamide, or rATG). * Active, uncontrolled systemic infection, or chronic active infection (including HIV, active Hepatitis B or C, or active tuberculosis). * Significant cardiac dysfunction (e.g., Left Ventricular Ejection Fraction \< 50%) or severe underlying pulmonary disease. * History of malignant neoplasm within the past 5 years, excluding successfully treated non-melanoma skin cancer or carcinoma in situ. * Previous autologous or allogeneic hematopoietic stem cell transplantation. * Pregnancy or breastfeeding. * Any psychiatric, medical, or geographical condition that, in the investigator's opinion, prevents compliance with the protocol and long-term follow-up.