Integrating APOL-1 Gene Variants Into Renal Transplantation: Considerations Arising From the American Society of Transplantation Expert Conference.

Thirteen percent of individuals of African Ancestry express two variant copies of the gene encoding Apolipoprotein 1 (APOL-1) that has been associated with an increased risk of ESRD in the general population. Limited studies suggest that the survival of transplanted kidneys from donors expressing two APOL-1 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 APOL-1 risk alleles who developed ESRD. Given the potential impact of APOL-1 variants on the utility and safety of kidney transplantation and living kidney donation the AST convened a meeting with the goals of summarizing the current state of knowledge with respect to transplantation and APOL-1, identifying knowledge gaps and studies to address these gaps, and considering approaches to integrating APOL-1 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 APOL-1 might currently be integrated into the clinical decision making process were considered. This manuscript summarizes the group's deliberations. This article is protected by copyright. All rights reserved.