Abstract: TH-PO0936
Kidney Transplant Clinical Outcomes by APOL1 Genotypes
Session Information
- Transplantation: Clinical - Glomerular Diseases, Infections, and Rejection
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Mandel, Mallory, Boston Children's Hospital, Boston, Massachusetts, United States
- Goral, Simin, Penn Medicine, Philadelphia, Pennsylvania, United States
- Doria, Cataldo, Capital Health, Trenton, New Jersey, United States
- Kopp, Jeffrey B., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
- Winkler, Cheryl Ann, National Cancer Institute Center for Cancer Research, Bethesda, Maryland, United States
- Rosas, Sylvia E., Joslin Diabetes and Endocrinology Research Center, Boston, Massachusetts, United States
Background
Apolipoprotein L1 (APOL1) high-risk genotypes (G1/G1, G1/G2, G2/G2) increase risk for APOL1-mediated kidney disease. Prior studies have focused on native kidney and kidney transplant outcomes, comparing high-risk and low-risk genotypes (G0/G0, G0/G1, G0/G2). Recent data suggest increased incidence of disease with monoallelic APOL1 variants and disparate outcomes between genotypes.
Methods
The Renal Transplant Outcome Study recruited kidney transplant recipients and genotyped for APOL1 risk alleles at three transplant centers in Philadelphia from 1999-2004. We evaluated clinical characteristics, graft survival, and rejection rates based on APOL1 genotype in the 221-recipient cohort.
Results
Age at transplant, diabetes prevalence, ESKD etiology, and ESKD age onset had associated differences between APOL1 genotypes (Figure 1). ESKD onset age was lowest for subjects with G1/G2 (35 yrs), followed by G1/G1 (39 yrs), G2/G2 (43 yrs), G0/G0 (46 years), G0/G1 (48 yrs) and G0/G2 (52 yrs) (p =0.0018). No genetic differences were found among the 45 rejection cases (p=0.47) or among the 69 allograft failures compared to other cases (p=0.996) (Figure 2).
Conclusion
Individuals with the APOL1 G1/G2 genotype developed ESKD 11 years earlier and those with the G1/G1 genotype developed ESKD 7 years earlier compared to G0/G0 individuals. Monoallelic genotypes did not have earlier ESKD onset compared to individuals with zero APOL1 risk alleles. No differences in acute rejection or graft failure rates were found.
Funding
- NIDDK Support