Kidney Week

Abstract: FR-PO1136

Replacing the Race Coefficient with a Coefficient for APOL1 Genotype to Predict Decreased Kidney Function After Living Kidney Donation

Session Information

• Transplantation: Clinical - Transplant Access, Recipient Evaluation, Living Donors, Pregnancy, and More
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States

Chi-yuan Hsu, MD, MSc, FASN

• Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States

Krista L. Lentine, MD, PhD, FASN

• Gao, Ying, University of California San Francisco, San Francisco, California, United States

Ying Gao

• Freedman, Barry I., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States

Barry I. Freedman, MD

• Lunn, Mitchell R., Stanford University School of Medicine, Stanford, California, United States

Mitchell R. Lunn, MD, MS, FASN

• Muiru, Anthony N., University of California San Francisco, San Francisco, California, United States

Anthony N. Muiru, MD, MPH

• Schnitzler, Mark, Saint Louis University, St. Louis, Missouri, United States

Mark Schnitzler, PhD

• Divers, Jasmin, New York University Grossman Long Island School of Medicine, Mineola, New York, United States

Jasmin Divers, PhD

• Mannon, Roslyn B., University of Nebraska Omaha, Omaha, Nebraska, United States

Roslyn B. Mannon, MD, FASN

• Palmer, Nicholette D., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States

Nicholette D. Palmer, PhD

• Karger, Amy B., University of Minnesota Medical School, Minneapolis, Minnesota, United States

Amy B. Karger, MD, PhD

• Park, Meyeon, University of California San Francisco, San Francisco, California, United States

Meyeon Park, MD, FASN

Group or Team Name

• for the APOL1 Long-Term Kidney Transplantation Outcomes Network (APOLLO) Consortium

Background

Increased efforts have been made in recent years to reduce the use of race in medical algorithms. Numerous models in kidney transplant, however, continue to include race (http://www.transplantmodels.com/), including one quantifying post-donation risk of end-stage kidney disease (ESKD) in living kidney donors (based on Massie et al., JASN, 2017 PMID 28450534). Using unique data from the Living Donor Extended Time Outcomes (LETO) study (Hsu et al., JAMA Intern Med, June 2026), we explored if the race coefficient (Black vs non-Black) can be replaced by a coefficient for apolipoprotein L1 (APOL1) genotype (high-risk vs not) in this setting.

Methods

LETO enrolled 445 Black kidney donors (68 with G1/G1, G2/G2, or G1/G2 APOL1 high-risk genotypes) and 208 White kidney donors (all assumed to not have high-risk APOL1 genotypes) at a median of 18.5 [IQR 16.9, 20.5] years after kidney donation. C-statistics were generated using logistic regression models. The primary outcome was eGFR <45 ml/min/1.73 m² (by the 2021 CKD-EPI creatinine equation), same as in the primary LETO manuscript.

Results

There were 34 cases of eGFR <45 ml/min/1.73 m² among Black donors and 12 among White donors. A model with age, race, sex, body mass index, and first-degree relationship to recipient (same predictors as Massie et al., JASN, 2017) had a C-statistic of 0.672 (95% CI: 0.591 to 0.753). Replacing the race coefficient with a coefficient for APOL1 genotype changed the C-statistic to 0.676 (95% CI: 0.583 to 0.770). After additionally considering pre-donation eGFR, the C-statistic for the model with race coefficient was 0.776 (95% CI: 0.698 to 0.854) and it changed to 0.786 (95% CI: 0.711 to 0.861) when the race coefficient was replaced with a coefficient for APOL1 genotype.

Conclusion

Compared with other studies which recruited living kidney donors years after nephrectomy to assess kidney health, LETO had the longest follow up and largest number of Black study participants. But we were not able to examine ESKD as the outcome (only 3 cases observed) and White donors were under-represented in LETO (by design). Our results suggest that an equation quantifying post-donation risk of reduced kidney function in living kidney donors with a coefficient for APOL1 genotype will perform similarly in terms of risk discrimination as an equation with a race coefficient.

Funding

• NIDDK Support