Association of Recipient APOL1 Kidney Risk Alleles With Kidney Transplant Outcomes.

Neil Roy, M Catalina Morales-Alvarez, Karim H Anis, Simin Goral, Cataldo Doria, Jeffrey B Kopp, Cheryl A Winkler, Rui Feng, Sylvia E Rosas

Journal: Transplantation 2023;107(12):2575-2580

PMID: 37527489

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Abstract

BACKGROUND

Kidney transplant survival in African American recipients is lower compared with non-African American transplant recipients. APOL1 risk alleles (RA) have been postulated as likely contributors. We examined the graft outcomes in kidney transplant recipients (KTRs) stratified by APOL1 RA status in a multicenter observational prospective study.

METHODS

The Renal Transplant Outcome Study recruited a cohort of incident KTRs at 3 transplant centers in the Philadelphia area from 1999-2004. KTRs were genotyped for APOL1 RA. Allograft and patient survival rates were compared by the presence and number of APOL1 RA.

RESULTS

Among 221 participants, approximately 43% carried 2 APOL1 RA. Recipients carrying 2 APOL1 RA demonstrated lower graft survival compared with recipients with only 1 or none of APOL1 RA at 1 y posttransplant, independently of other donor and recipient characteristics (adjusted hazard ratio 3.2 [95% confidence interval, 1.0-10.4], P = 0.05). There was no significant difference in overall survival or graft survival after 3 y posttransplantation. There was no difference in death by APOL1 -risk status ( P = 0.11).

CONCLUSIONS

Recipients with 2 APOL1 high-risk alleles exhibited lower graft survival 1 y posttransplantation compared with recipients with only 1 or 0 APOL1 RA. Further research is required to study the combined role of the recipient and donor APOL1 genotypes in kidney transplantation.

Address: Kidney and Hypertension Unit, Joslin Diabetes Center, Boston, MA.; Nephrology Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.; Division of Renal, Electrolyte, and Hypertension, Department of Medicine, University of Pennsylvania, Philadelphia, PA.; Capital Health Cancer Center, Pennington, NJ.; Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney, National Institutes of Health, Bethesda, MD.; Cancer Innovation Laboratory, Center for Cancer Research, National Cancer Institute and the Basic Research Program, Frederick National Laboratory, Frederick, MD.; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

DOI: 10.1097/TP.0000000000004742