APOL1 Donor Gene Linked to Renal Graft Survival

Graft survival significantly shorter in donor kidneys with two APOL1 risk variants

TUESDAY, May 31 (HealthDay News) -- Significantly shorter renal allograft survival is seen in recipients of kidneys donated by African-American (AA) donors with two apolipoprotein L1 gene (APOL1) risk variants compared to patients receiving a kidney from a donor with zero or one risk variant, according to a study published in the May issue of the American Journal of Transplantation.

Amber M. Reeves-Daniel, D.O., from the Wake Forest University School of Medicine in Winston-Salem, N.C., and colleagues investigated the effect of transplanting kidneys from AA donors with two APOL1 nephropathy risk variants. Genotyping of APOL1 risk variants was carried out in 106 AA deceased organ donors, and graft survival was evaluated in the 136 kidney recipients. The association between time to graft failure and donor APOL1 genotypes was assessed during an average follow-up of 26.4 months.

The investigators found that 16 percent of the transplanted kidneys were from AA donors with two APOL1 nephropathy risk variants. Of the 25 grafts that failed, 32 percent had two APOL1 risk variants. Graft survival was significantly shorter in donor kidneys with two APOL1 risk variants and higher human leukocyte antigen (HLA) mismatch (hazard ratio, 3.84 and 1.52, respectively), after accounting for recipient age and gender, donor APOL1 genotype, overall African ancestry, expanded criteria donation, HLA mismatch, cold ischemia times, and panel reactive antibody. Overall African ancestry, excluding APOL1, did not affect the graft survival time.

"Our findings suggest that donor kidney APOL1 genotypes have the potential to improve the donor selection process, potentially resulting in optimization of long-term renal allograft function," the authors write.

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