APOL1 Variants in Patients Undergoing Kidney Transplantation

May 2020 Council

Lead Division/Office

KUH

Point(s) of Contact

Paul L. Kimmel, M.D., M.A.C.P.; Afshin Parsa, M.D., M.P.H.

Executive Summary

African Americans have higher incident end-stage renal disease rates than European Americans. APOL1 variants on Chromosome 22 have been linked with non-diabetic kidney disease, focal glomerulosclerosis and hypertension-attributed kidney disease. Kidney transplantation is an area where prospective screening for APOL1 susceptibility variants may have important clinical implications. The implications of APOL1 status in living donors are important as the consequences of kidney donation in people with 1 or more variants are unknown. It is unclear whether APOL1 should be tested routinely in either donors or recipients, highlighting the need for rigorous studies using information from paired donors and recipients, with evaluations of both genotypes and longitudinal kidney outcomes. The APOLLO study was funded in September 2017, as a result of RFAs DK 16-024 and 16-025. The study involves a longitudinal multicenter prospective assessment of African American donors and recipients, including evaluation of APOL1 genotypes and transplant outcomes in recipients who received a kidney from an African- American donor. Analyses will assess outcomes in those who received a kidney with 2 APOL1 variants, compared with appropriate controls. To achieve recruitment goals and have sufficient time for evaluation of events, the study must be extended in time. The current initiative will extend the study period from September 2022 to September 2027.