African American Living-Kidney Donors Should Be Screened for APOL1 Risk Alleles

Cohen, David; Mittalhenkle, Anuja; Scott, David; Young, Carlton J.; Norman, Douglas J.

doi:10.1097/tp.0b013e31822eec39

Cited by 60 publications

(58 citation statements)

References 15 publications

(20 reference statements)

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“…[9,10] Recently identified genetic mutations in the APOL1 gene in African American living donors may also impact adversely on graft function after donation. [11,12] Our preliminary findings …”

Section: Discussionmentioning

confidence: 99%

Favourable outcomes for the first 10 years of kidney and pancreas transplantation at Wits Donald Gordon Medical Centre, Johannesburg, South Africa

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Favourable outcomes for the first 10 years of kidney and pancreas transplantation at Wits Donald Gordon Medical Centre, Johannesburg, South Africa

et al. 2016

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“…For instance, after LKD, blacks have higher risks of ESRD and hypertension and Hispanics have higher risks of hypertension compared with non-Hispanic whites (20,21). Although the discovery of a genetic marker (i.e., APOL1) to predict risk of future kidney disease in blacks may hold some promise in attenuating this disparity in living donor outcome, it has not yet been integrated into the clinical evaluation of potential living donors (22)(23)(24). As noted by Tan et al (25) in this issue of CJASN, the lack of consensus about how best to screen potential living donors in these racial/ ethnic groups may be contributing to variable eligibility criteria at transplant programs and heightened uncertainty by potential donors.…”

Section: Race/ethnicitymentioning

confidence: 99%

Living Donor Kidney Transplantation

Rodrigue

Kazley

Mandelbrot

et al. 2015

Clinical Journal of the American Society of Nephrology

107

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Despite its superior outcomes relative to chronic dialysis and deceased donor kidney transplantation, live donor kidney transplantation (LDKT) is less likely to occur in minorities, older adults, and poor patients than in those who are white, younger, and have higher household income. In addition, there is considerable geographic variability in LDKT rates. Concomitantly, in recent years, the rate of living kidney donation (LKD) has stopped increasing and is declining, after decades of consistent growth. Particularly noteworthy is the decline in LKD among black, younger, male, and lower-income adults. The Live Donor Community of Practice within the American Society of Transplantation, with financial support from 10 other organizations, held a Consensus Conference on Best Practices in Live Kidney Donation in June 2014. The purpose of this meeting was to identify LKD best practices and knowledge gaps that might influence LDKT, with a focus on patient and donor education, evaluation efficiencies, disparities, and systemic barriers to LKD. In this article, we discuss trends in LDKT/LKD and emerging novel strategies for attenuating disparities, and we offer specific recommendations for future clinical practice, education, research, and policy from the Consensus Conference Workgroup focused on disparities.

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“…[9][10][11] However, much of the evidence supporting such a program is derived from studies of populations with CKD. 6 Patterns of eGFR decline may differ between general and CKD populations.…”

mentioning

confidence: 99%

Race, APOL1 Risk, and eGFR Decline in the General Population

Grams

Rebholz²,

Chen³

et al. 2016

JASN

127

125

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The APOL1 high-risk genotype, present in approximately 13% of blacks in the United States, is a risk factor for kidney function decline in populations with CKD. It is unknown whether genetic screening is indicated in the general population. We evaluated the prognosis of APOL1 high-risk status in participants in the population-based Atherosclerosis Risk in Communities (ARIC) study, including associations with eGFR decline, variability in eGFR decline, and related adverse health events (AKI, ESRD, hypertension, diabetes, cardiovascular disease, pre-ESRD and total hospitalization rate, and mortality). Among 15,140 ARIC participants followed from 1987-1989 (baseline) to 2011-2013, 75.3% were white, 21.5% were black/APOL1 low-risk, and 3.2% were black/APOL1 high-risk. In a demographic-adjusted analysis, blacks had a higher risk for all assessed adverse health events; however, in analyses adjusted for comorbid conditions and socioeconomic status, blacks had a higher risk for hypertension, diabetes, and ESRD only. Among blacks, the APOL1 high-risk genotype associated only with higher risk of ESRD in a fully adjusted analysis. Black race and APOL1 high-risk status were associated with faster eGFR decline (P,0.001 for each). However, we detected substantial overlap among the groups: median (10th-90th percentile) unadjusted eGFR decline was 1.5 (1.0-2.2) ml/min per 1.73 m 2 per year for whites, 2.1 (1.4-3.1) ml/min per 1.73 m 2 per year for blacks with APOL1 low-risk status, and 2.3 (1.5-3.5) ml/min per 1.73 m 2 per year for blacks with APOL1 high-risk status. The high variability in eGFR decline among blacks with and without the APOL1 high-risk genotype suggests that population-based screening is not yet justified.

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African American Living-Kidney Donors Should Be Screened for APOL1 Risk Alleles

Cited by 60 publications

References 15 publications

Favourable outcomes for the first 10 years of kidney and pancreas transplantation at Wits Donald Gordon Medical Centre, Johannesburg, South Africa

Favourable outcomes for the first 10 years of kidney and pancreas transplantation at Wits Donald Gordon Medical Centre, Johannesburg, South Africa

Living Donor Kidney Transplantation

Race, APOL1 Risk, and eGFR Decline in the General Population

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