title: Testing for High-Risk APOL1 Alleles in Potential Living Kidney Donors.
abstract: Accurate risk assessment is critical when evaluating potential living kidney donors. High-risk kidney APOL1 variants have been associated with end-stage renal disease of multiple causes among African Americans, though the predictive power of these variants in population-based studies is small. No studies have looked at the effect of high-risk APOL1 alleles on donor outcomes, though few transplantation centers in the United States offer screening for APOL1 among African American donors. Screening all African Americans for high-risk APOL1 alleles may result in the exclusion of many potential donors (∼13% of African Americans). Such an exclusion may have a large effect on the availability of transplants for African Americans, who are already less likely to undergo transplantation. Nephrologists should be prepared to discuss with potential African American donors the relative increase in risk that is likely conferred by carrying 2 high-risk APOL1 alleles and how additional factors such as environmental exposures (eg, viral infections) and/or other genetic susceptibilities may be required for developing kidney disease. In this Perspective, we review the use of APOL1 testing for risk stratification of potential African American kidney donors.
authors.affiliation: Department of Medicine, Renal Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: lriella@rics.bwh.harvard.edu.
authors.forename: Leonardo V
authors.initials: LV
authors.lastname: Riella
authors.affiliation: Department of Medicine, Renal Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Alice M
authors.initials: AM
authors.lastname: Sheridan
mesh_terms: D001741:Black or African American / Q000235:genetics*; D000075944:Apolipoprotein L1; D001053:Apolipoproteins / Q000235:genetics*; D046148:Donor Selection / Q000379:methods; D020022:Genetic Predisposition to Disease; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D007676:Kidney Failure, Chronic / Q000235:genetics / Q000601:surgery; D016030:Kidney Transplantation; D008075:Lipoproteins, HDL / Q000235:genetics*; D019520:Living Donors; D051436:Renal Insufficiency, Chronic / Q000235:genetics; D018570:Risk Assessment
chemical_list: C108666:APOL1 protein, human; D000075944:Apolipoprotein L1; D001053:Apolipoproteins; D008075:Lipoproteins, HDL
keywords: APOL1 gene; African American; Living kidney donation; apolipoprotein L1; contraindication; donor screening; end-stage renal disease (ESRD); genetic susceptibility; high-risk allele; kidney donor evaluation; kidney failure; medical ethics; racial difference; renal transplantation; risk stratification