APOL1 Genotype and Kidney Transplantation Outcomes From Deceased African American Donors.

Abstract:

BACKGROUND:Two apolipoprotein L1 gene (APOL1) renal-risk variants in donors and African American (AA) recipient race are associated with worse allograft survival in deceased-donor kidney transplantation (DDKT) from AA donors. To detect other factors impacting allograft survival from deceased AA kidney donors, APOL1 renal-risk variants were genotyped in additional AA kidney donors. METHODS:The APOL1 genotypes were linked to outcomes in 478 newly analyzed DDKTs in the Scientific Registry of Transplant Recipients. Multivariate analyses accounting for recipient age, sex, race, panel-reactive antibody level, HLA match, cold ischemia time, donor age, and expanded criteria donation were performed. These 478 transplantations and 675 DDKTs from a prior report were jointly analyzed. RESULTS:Fully adjusted analyses limited to the new 478 DDKTs replicated shorter renal allograft survival in recipients of APOL1 2-renal-risk-variant kidneys (hazard ratio [HR], 2.00; P = 0.03). Combined analysis of 1153 DDKTs from AA donors revealed donor APOL1 high-risk genotype (HR, 2.05; P = 3 × 10), older donor age (HR, 1.18; P = 0.05), and younger recipient age (HR, 0.70; P = 0.001) adversely impacted allograft survival. Although prolonged allograft survival was seen in many recipients of APOL1 2-renal-risk-variant kidneys, follow-up serum creatinine concentrations were higher than that in recipients of 0/1 APOL1 renal-risk-variant kidneys. A competing risk analysis revealed that APOL1 impacted renal allograft survival, but not recipient survival. Interactions between donor age and APOL1 genotype on renal allograft survival were nonsignificant. CONCLUSIONS:Shorter renal allograft survival is reproducibly observed after DDKT from APOL1 2-renal-risk-variant donors. Younger recipient age and older donor age have independent adverse effects on renal allograft survival.

journal_name

Transplantation

journal_title

Transplantation

authors

Freedman BI,Pastan SO,Israni AK,Schladt D,Julian BA,Gautreaux MD,Hauptfeld V,Bray RA,Gebel HM,Kirk AD,Gaston RS,Rogers J,Farney AC,Orlando G,Stratta RJ,Mohan S,Ma L,Langefeld CD,Bowden DW,Hicks PJ,Palmer ND,Pala

doi

10.1097/TP.0000000000000969

subject

Has Abstract

pub_date

2016-01-01 00:00:00

pages

194-202

issue

1

eissn

0041-1337

issn

1534-6080

journal_volume

100

pub_type

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