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Abstract: SA-OR008

Association of Recipient APOL1 Kidney Risk Alleles and Hepatitis C Status with Kidney Transplant Outcomes

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical


  • Anis, Karim H., Joslin Diabetes Center, Boston, Massachusetts, United States
  • Goral, Simin, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Kopp, Jeffrey B., NIDDK, NIH, Bethesda, Maryland, United States
  • Winkler, Cheryl Ann, NCI, NIH, Frederick National Laboratory, Frederick, Maryland, United States
  • Feng, Rui, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Rosas, Sylvia E., Joslin Diabetes Center, Boston, Massachusetts, United States

African-Americans (AA) are more likely to have worse kidney transplant outcomes compared to non-AA transplant recipients. The mechanism is unknown but the APOL1 risk alleles (RA) have been postulated as likely contributors. Given the high prevalence of APOL1 RA in AA a two-hit theory has been embraced. We examined the outcomes of kidney transplant recipients (KTR) stratified by APOL1 RA and hepatitis C virus (HCV) antibody status.


We conducted a multicenter observational prospective study of incident KTR. Incident KTR were genotyped for APOL1 RA. Baseline characteristics and graft survival rates were compared by number of APOL1 RA and/or by HCV antibody presence.


Among 221 participants, approximately 43% had 2 APOL1 RA. The prevalence of HCV antibody in the cohort was 17%. KTR with 2 APOL1 RA were younger compared to those with none or one APOL1 RA [51.8 vs 42.2 years old, P<0.0001]. Two APOL1 RA was associated with early (prior to 1500 days) [1.98 (95% CI 1.01-3.85); P=0.045], but not late graft failure (up to 2000 days) [HR 1.39 (95% CI 0.79-2.45); P=0.25] adjusted for acute rejection and age at transplant. However, recipients with both two APOL1 RA and HCV antibodies demonstrated lower graft survival compared to recipients with only one or none of those risk factors. [HR 2.74(95%CI 1.06-7.10); P=0.04].


Our study demonstrates the effect of APOL1 risk status in KTR on graft survival. Furthermore, it illustrates that the effect of recipient APOL1 RA on graft outcome may be altered by viral infections such as HCV and is likely time dependent.


  • NIDDK Support