Abstract: FR-PO1148
Effect of Donor APOL1 Genotype on 14-Year Living Donor Kidney Transplant Graft and Patient Survival: Results from the Living Donor Extended Time (LETO) Study
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
- Lentine, Krista L., Saint Louis University, St. Louis, Missouri, United States
- Park, Meyeon, University of California San Francisco, San Francisco, California, United States
- Xiao, Huiling, Saint Louis University, St. Louis, Missouri, United States
- Mannon, Roslyn B., University of Nebraska Medical Center, Omaha, Nebraska, United States
- Muiru, Anthony N., University of California San Francisco, San Francisco, California, United States
- Gao, Ying, University of California San Francisco, San Francisco, California, United States
- Lunn, Mitchell R., University of California San Francisco, San Francisco, California, United States
- Freedman, Barry I., Wake Forest University, Winston-Salem, North Carolina, United States
- Divers, Jasmin, New York University, New York, New York, United States
- Palmer, Nicholette D., Wake Forest University, Winston-Salem, North Carolina, United States
- Karger, Amy B., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Schnitzler, Mark, Saint Louis University, St. Louis, Missouri, United States
- Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
Background
Limited data exist on the impact of living kidney donor (LKD) the apolipoprotein L1 (APOL1) genotype on the long-term outcomes of living donor kidney transplant recipients (LDKTr).
Methods
The Living Donor Extended Time Outcomes (LETO) study enrolled Black U.S. LKD who donated between 2000–2008 and performed health assessments with APOL1 genotyping. Using linked SRTR data with 14-year follow-up, we evaluated graft and patient survival (PS) among LKRTr by donor APOL1 genotype. PS among LKRTr from donors with high-risk APOL1 genotypes (2 renal risk variants [RRV]) or low-risk genotypes (0/1 RRV) was compared with propensity-matched kidney transplant candidates (KTxC). Life-year (LY) differences were estimated using Restricted Mean Survival Time methods.
Results
Among 445 enrolled Black LKD, 68 (15.3%) had a high-risk APOL1 genotype; 95.3% of LKRTr from Black LKD were Black. Compared with LDKTr from APOL1 low-risk LKD, LKRTr from high-risk LKD were younger (40 vs 46 yr), more often had ESKD from glomerulonephritis (33.8% vs 18.3%), and were more often first-degree relatives of their LKD (72.1% vs 63.9%).
All-cause graft survival was lower among LKRTr from LKD with 2 APOL1 RRV vs 0/1 RRV (40.0% vs 54.0%, P=0.011) (Fig A). At 14 years, LKRTr from LKD with 0/1 RRV had better PS and life-years (68.4%, 12.3 LY) than matched KTxC recipients (55.1%, 10.6 LY) (Fig B). In contrast, outcomes were similar between LKRTr from donors with 2 RRV (69.1%, 12.1 LY) and matched KTxC recipients (67.6%, 11.8 LY) (Fig C). LKRTr from donors with 0/1 RRV gained a significant 1.6 LY benefit vs matched KTxC (P=0.001), whereas no benefit was seen with 2 RRV donors (0.3 LY, P=0.54) (Fig D).
Conclusion
LKRTr from Black LKD with 0/1 APOL1 RRV had better PS than matched KTxC, but this benefit was not seen with transplant from LKD with 2 APOL1 RRV. Given potential LKD risks and limited LDKTr survival benefit, caution is warranted when approving donation from individuals with 2 APOL1 RRV.
Acknowledgment
The Living Donor Extended Time Outcomes (LETO) study is funded by the National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK120551 and R01 DK120551-02S1).
Funding
- NIDDK Support