Apolipoprotein L1 and Chronic Kidney Disease Risk in Young Potential Living Kidney Donors

Locke, Jayme E.; Sawinski, Deirdre; Reed, Rhiannon D.; Shelton, Brittany A.; MacLennan, Paul A.; Kumar, Vineeta; Mehta, Shikha; Mannon, Roslyn B.; Gaston, Robert S.; Julian, Bruce A.; Carr, J. Jeffrey; Terry, James G.; Kilgore, Meredith L.; Massie, Allan B.; Segev, Dorry L.; Lewis, Cora E.

doi:10.1097/sla.0000000000002174

Cited by 50 publications

(49 citation statements)

References 48 publications

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“…AA living kidney donors, especially AA women, compared to Whites have a higher risk of renal function decline post-donation [17], particularly individuals with a genetic predisposition. Indeed, the presence of 2 apolipoprotein L1 kidney risk alleles (APOL1) risk variants has been shown to increase the 25-year renal risk for 18-year-old AAs without baseline abnormalities (1.46% for women; 2.53% for men) and for those with baseline abnormalities (from 2.53 to 6.23% for women and from 4.35 to 10.58% for men) [18]. Although, few centers offer APOL1 genetic screening, the increased risk for developing post-donation CKD may thus impact the potential donor’s eligibility or willingness to donate.…”

Section: Racial Disparities In Living Donor Kidney Transplantation Ammentioning

confidence: 99%

Health Disparities in Kidney Transplantation for African Americans

Harding¹,

Mersha

Pham

et al. 2017

Am J Nephrol

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Background: The persistent challenges of bridging healthcare disparities for African Americans (AAs) in need of kidney transplantation continue to be unresolved at the national level. This healthcare disparity is multifactorial: stemming from limited kidney donors suitable for AAs; inconsistent care coordination and suboptimal risk factor control; social determinants, low socioeconomic status, reduced access to care; and mistrust of clinicians and the healthcare system. Summary: There are numerous opportunities to significantly lessen the disparities in kidney transplantation for AAs through the following measures: the adoption of new care and patient engagement models that include education, enhanced practice-level cultural sensitivity, and timely referral as well as increased research on the impact of the environment on genetic risk, and implementation of new transplantation-related policies. Key Messages: This systematic review describes pretransplant concerns related to access to kidney transplantation, posttransplant complications, and policy interventions to address the challenging issues associated with kidney transplantation in AAs.

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Section: Racial Disparities In Living Donor Kidney Transplantation Ammentioning

confidence: 99%

Health Disparities in Kidney Transplantation for African Americans

Harding¹,

Mersha

Pham

et al. 2017

Am J Nephrol

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“…Numerous studies 4,[12][13][14][15][16][17][18][19] have found a relationship between race and risk of ESRD among LKDs, but the mechanisms responsible remain unclear. Despite evidence regarding the role of APOL1 as a risk factor in people of African descent, [20][21][22][23][24][25] disparities in access to health care among racial minorities in the United States 26 raise the question of whether differences are explained primarily by genetic factors 27,28 or also by other factors, such as socioeconomic status (SES). Garg and colleagues found that lower income was associated with higher risk of death or first major cardiovascular event for a cohort of mostly white LKDs, 11 and Lentine and colleagues investigated the role of SES on donor outcomes and found no significant associations, but cohort limitations likely limited the effect of SES.…”

Section: Introductionmentioning

confidence: 99%

Risk of ESRD in prior living kidney donors

Wainright¹,

Robinson²,

Wilk³

et al. 2018

American Journal of Transplantation

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We studied End-Stage Renal Disease (ESRD) in living kidney donors (LKDs) who donated in the United States between 1994 and 2016 (n = 123 526), using Organ Procurement and Transplantation Network and Centers for Medicare and Medicaid Services data. Two hundred eighteen LKDs developed ESRD, with a median of 11.1 years between donation and ESRD. Absolute 20-year risk was low but not uniform, with risk associated with race, age, and sex and increasing exponentially over time. LKDs had increased risk of ESRD if they were male (adjusted hazard ratio [aHR]: 1.75, 95% confidence interval [95%CI]: 1.33-2.31), had higher BMI (aHR: 1.34 per 5 kg/m , 95%CI: 1.10-1.64) or lower estimated GFR (aHR: 0.89 per 10 mL/min, 95% CI: 0.80-0.99), were first-degree relatives of the recipient (parent: [aHR: 2.01, 95% CI: 1.26-3.21]; full sibling [aHR: 1.87, 95%CI: 1.23-2.84]; identical twin [aHR: 19.79, 95%CI: 7.65-51.24]), or lived in lower socioeconomic status neighborhoods at donation (aHR: 0.87 per $10k increase; 95%CI: 0.77-0.99). We found a significant interaction between donation age and race, with higher risk at older ages for white LKDs (aHR: 1.26 per decade, 95%CI: 1.04-1.54), but higher risk at younger ages for black LKDs (aHR: 0.75 per decade, 95%CI: 0.57-0.99). These findings further inform risk assessment of potential LKDs.

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“…30,31 Locke and associates recently developed a novel method of determining future CKD risk based on apolipoprotein L1 risk variants in patients with no other absolute contraindications. 32 They demonstrated that this risk is particularly prominent in young AA patients. We are unfortunately unable to provide information on potential genetic risk variants in our AA recipients.…”

Section: Figure 3 Patient Survival By Race/ethnicitymentioning

confidence: 99%

Alemtuzumab Induction Is Associated With an Equalization of Outcomes Between White and African American Kidney Transplant Recipients

Brooks

Mitro²,

DeLeonibus³

et al. 2019

Exp Clin Transplant

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Objectives: Our aim was to assess outcomes in White and African American kidney transplant recipients after induction with alemtuzumab. Materials and Methods:We performed a retrospective study of 464 patients who received deceased-donor kidney transplants and were induced with alem tuzumab between March 2006 and May 2015. We evaluated ethnic influences on patient and graft survival, delayed graft function, allograft failure, and rejection. Results: There were 337 White (67.3%) and 127 African American (25.3%) patients. We observed no significant differences in 1-, 3-, 5-, and 7-year death-censored graft survival. We also observed no significant differences in 1-, 3-, and 5-year patient survival rates. Having African American ethnicity was not a significant predictor of rejection, graft survival, or patient survival. Conclusions: Our results indicate that recipient ethnicity is not a predictor of rejection, graft survival, or patient survival. White and African American kidney transplant recipients induced with alemtuzumab experienced an equalization of outcomes.

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Apolipoprotein L1 and Chronic Kidney Disease Risk in Young Potential Living Kidney Donors

Abstract: Young AAs were at highest risk for CKD, and APOL1 renal-risk variants drove some of this risk. Understanding the genetic profile of young AA potential living kidney donors in the context of baseline health characteristics may help to inform candidate selection and counseling.

Cited by 50 publications

References 48 publications

Health Disparities in Kidney Transplantation for African Americans

Health Disparities in Kidney Transplantation for African Americans

Risk of ESRD in prior living kidney donors

Alemtuzumab Induction Is Associated With an Equalization of Outcomes Between White and African American Kidney Transplant Recipients

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