title: Integrating APOL1 Gene Variants Into Renal Transplantation: Considerations Arising From the American Society of Transplantation Expert Conference.
abstract: Thirteen percent of individuals of African ancestry express two variant copies of the gene encoding apolipoprotein 1 (APOL1) that has been associated with an increased risk of end-stage renal disease (ESRD) in the general population. Limited studies suggest that the survival of transplanted kidneys from donors expressing two APOL1 risk alleles is inferior to that of kidneys from donors with zero or one risk allele. In living kidney donation, two case reports describe donors expressing two APOL1 risk alleles who developed ESRD. Given the potential impact of APOL1 variants on the utility and safety of kidney transplantation and living kidney donation, the American Society of Transplantation convened a meeting with the goals of summarizing the current state of knowledge with respect to transplantation and APOL1, identifying knowledge gaps and studies to address these gaps, and considering approaches to integrating APOL1 into clinical practice. The authors recognize that current data are not sufficient to support traditional evidence-based guidelines but also recognize that it may require several years to generate the necessary data. Thus, approaches as to how APOL1 might currently be integrated into the clinical decision-making process were considered. This report summarizes the group's deliberations.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: K A
authors.initials: KA
authors.lastname: Newell
authors.affiliation: Department of Medicine, Yale University School of Medicine, New Haven, CN.
authors.forename: R N
authors.initials: RN
authors.lastname: Formica
authors.affiliation: Division of Nephrology, Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada.
authors.forename: J S
authors.initials: JS
authors.lastname: Gill
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: J D
authors.initials: JD
authors.lastname: Schold
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard University, Boston, MA.
authors.forename: J S
authors.initials: JS
authors.lastname: Allan
authors.affiliation: American Society of Transplantation, Mt. Laurel, NJ.
authors.forename: S H
authors.initials: SH
authors.lastname: Covington
authors.affiliation: University of Colorado, Denver, CO.
authors.forename: A C
authors.initials: AC
authors.lastname: Wiseman
authors.affiliation: Schuster Family Transplantation Research Center, Renal Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: A
authors.initials: A
authors.lastname: Chandraker
mesh_terms: D000075944:Apolipoprotein L1 / Q000235:genetics*; D000066491:Clinical Decision-Making; D003226:Congresses as Topic; D014644:Genetic Variation; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D016030:Kidney Transplantation; D010818:Practice Patterns, Physicians' / Q000592:standards*
chemical_list: C108666:APOL1 protein, human; D000075944:Apolipoprotein L1
keywords: clinical research/practice; disparities; donors and donation; ethics and public policy; genetics; graft survival; kidney disease; kidney transplantation/nephrology