APOL1 Improves Risk Prediction in African American Deceased Donors

A revised Kidney Donor Risk Index (KDRI) incorporating APOL1 genotype rather than race improves prediction of allograft survival of kidneys from African American deceased donors, reports a study in American Journal of Transplantation.

The study included data on 622 African American deceased kidney donors from three southern US centers. The researchers used a series of models to analyze the impact of a revised KDRI substituting APOL1 genotype for race.

For all donors, mean current KDRI was 1.4930. With the revised KDRI, the risk score decreased to 1.2518 for 529 donors with no or one APOL1 risk variant, but increased to 1.8527 for 93 donors with two risk variants. Posttransplant survival prediction errors were comparable for the original and revised equations. However, there was a 37-percentage point spread in the Kidney Donor Profile Index score, based on the presence or absence of two APOL1 risk variants.

Time to allograft failure is shorter in kidneys from African American deceased donors with two APOL1 risk variants. The new analysis suggests that using APOL1 genotype instead of race as a risk factor in the KDRI might give a better prediction of the risks associated with transplanting organs from these donors.

The revised model using APOL1 genotype improves KDRI score for 85% to 90% of kidneys from African American deceased donors. While emphasizing the need for further research, the authors discuss the implications for improving the link between the quality of donor organs and the need of the recipient [Julian BA, et al. Effect of replacing risk with apolipoprotein L1 genotype in calculation of Kidney Donor Risk Index. Am J Transpl 2017; 17:1540–1548].

July 2017 (Vol. 9, Number 6)