Apolipoprotein L1 Gene Effects on Kidney Transplantation

Semin Nephrol. 2017 Nov;37(6):530-537. doi: 10.1016/j.semnephrol.2017.07.006.

Abstract

The pathogenesis of many common etiologies of nephropathy has been informed by recent molecular genetic breakthroughs. It now is apparent that the ethnic disparity in the risk for nondiabetic chronic kidney disease between African Americans and European Americans is explained largely by variation in the apolipoprotein L1 gene (APOL1). The presence of two APOL1 renal risk variants markedly increases an individual's risk for kidney disease. In transplantation, kidneys from deceased African Americans with two APOL1 renal risk variants have shorter survival intervals after engraftment, regardless of the ethnicity of the recipient. Precision medicine will transform the clinical practice of nephrology and kidney transplantation, and play an important role in the allocation of kidneys from deceased and living kidney donors with recent African ancestry. This article reviews existing data on APOL1 in deceased-donor and living-donor kidney transplantation. It considers the impact of including APOL1 genotyping in decisions on the allocation and discard of deceased-donor kidneys, as well as the selection of living donors.

Keywords: APOL1; African American; allocation; chronic kidney disease; kidney transplantation; organ donation.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • African Americans / genetics*
  • Apolipoprotein L1 / genetics*
  • Donor Selection
  • Genetic Testing
  • Genotype
  • Genotyping Techniques
  • Graft Survival / genetics*
  • Humans
  • Kidney Transplantation*
  • Living Donors / statistics & numerical data
  • Mutation
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / genetics*
  • Renal Insufficiency, Chronic / surgery
  • Resource Allocation

Substances

  • APOL1 protein, human
  • Apolipoprotein L1