APOL1 Genotype Affects Outcomes of Transplantation from African American Donors

The presence of APOL1 gene variants in African American kidney donors influences the risk of allograft failure after kidney transplantation, reports a study in American Journal of Transplantation.

The researchers performed genotyping for apolipoprotein L1 gene G1 and G2 variants in DNA samples from African American deceased donors of kidneys recovered, transplanted, or both in Alabama and North Carolina. The association of APOL1 genotype findings with kidney transplantation outcomes at 55 centers was assessed. The findings were adjusted for recipient age, sex, and race/ethnicity; HLA matching; cold ischemia time; panel reactive antibody levels; and donor type.

Analysis of 221 kidneys recovered in Alabama showed a trend toward shorter allograft survival in patients receiving kidneys with two APOL1 risk variants. For the total of 675 transplanted kidneys, allograft failure risk was significantly increased with APOL1 genotype, hazard ratio 2.26; and African American donor race/ethnicity, hazard ratio 1.60. For 99 kidneys with two APOL1 risk variants, allograft survival decreased from 89.3 percent at 1 year to 73.0 percent at 5 years to 54.5 percent at 10 years.

A previous single-center study reported lower renal allograft survival associated with APOL1 risk variants in African American deceased kidney donors. The new findings in a large, multicenter sample of African American donors show an increased risk of allograft failure after transplantation of kidneys with two APOL1 nephropathy variants. “These findings warrant consideration of rapidly genotyping deceased African American kidney donors for APOL1 risk variants at organ recovery and incorporation of results into allocation and informed-consent processes,” the researchers write. [Freedman BI, et al. Apolipoprotein L1 gene variants in deceased organ donors are associated with renal allograft failure. Am J Transplant 2015; 15:1615–1622].