Abstract: FR-PO1137
Monoallelic Apolipoprotein 1 Variants in Living Kidney Donors Are Associated with Impaired Long-Term Graft Survival: Results from the Brazilian Investigation on Donor Genetic Evaluations
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
- Tavares, Melissa Gaspar, Universidade Federal de Sao Paulo Hospital do Rim e Hipertensao, São Paulo, SP, Brazil
- Ferreira, Luisa Queiroga, Universidade Federal de Sao Paulo Hospital do Rim e Hipertensao, São Paulo, SP, Brazil
- Ferreira, Guilherme De Sousa, Universidade Federal de Sao Paulo Hospital do Rim e Hipertensao, São Paulo, SP, Brazil
- Godoi, Leonardo Moura, Universidade Federal de Sao Paulo Hospital do Rim e Hipertensao, São Paulo, SP, Brazil
- Soares, Marina Oliveira Melo, Universidade Federal de Sao Paulo Hospital do Rim e Hipertensao, São Paulo, SP, Brazil
- Finamor, Rhaon Pietro Santos, Universidade Federal de Sao Paulo Hospital do Rim e Hipertensao, São Paulo, SP, Brazil
- Oliveira Alves Lima, Roberta, Universidade Federal de Sao Paulo Hospital do Rim e Hipertensao, São Paulo, SP, Brazil
- Tedesco-Silva, Helio, Universidade Federal de Sao Paulo Escola Paulista de Medicina, São Paulo, SP, Brazil
- Foresto, Renato Demarchi, Universidade Federal de Sao Paulo Hospital do Rim e Hipertensao, São Paulo, SP, Brazil
- Medina-Pestana, Jose, Universidade Federal de Sao Paulo Hospital do Rim e Hipertensao, São Paulo, SP, Brazil
- Requiao-Moura, Lucio Roberto, Universidade Federal de Sao Paulo Hospital do Rim e Hipertensao, São Paulo, SP, Brazil
Group or Team Name
- BRIDGES - APOL1
Background
This study aimed to determine the frequency of high-risk APOL1 variants among Brazilian living kidney donors and to evaluate their impact on long-term graft survival in kidney transplant recipients.
Methods
This study included 539 living-donor pairs transplanted 2008 and 2015, with a minimum follow-up of 10 years after transplantation. Recipients were stratified according to the presence of donor APOL1 risk variants: G0/G0 versus ≥1 risk variant. Graft survival was estimated using the Kaplan–Meier method, and multivariable analysis was performed using Cox proportional hazards regression.
Results
Overall, 16.8% of donors carried at least one APOL1 risk variant: 11.1% had G0/G1, 4.5% had G0/G2, 1.2% had G1/G2, and no G2/G2 cases were identified. Among G0/G0 donors, 62.1% self-identified as White and 37.9% as Black or Brown (p=0.01). Donors had a mean age of 45.4 years, 62% were female, and 53.2% were siblings of their recipients. Recipients of kidneys from donors carrying ≥1 APOL1 risk variant were more frequently Black or Brown (62.6% vs. 47.3%, p=0.008) and were less likely to have undergone preemptive transplantation (7.7% vs. 16.7%, p=0.03). Induction therapy with thymoglobulin or basiliximab was administered in 31.9% of recipients. Maintenance immunosuppression predominantly consisted of a calcineurin inhibitor combined with azathioprine (69.8%), with no significant differences between groups. At 10 years, death-uncensored graft survival was 88.3% among recipients of kidneys from G0/G0 donors and 81.7% among recipients of kidneys from donors carrying ≥1 APOL1 risk variant (HR=1.622; 95% CI=1.003–2.624; p=0.049). In the multivariable analysis, longer time on dialysis before transplantation (HR per year=1.076; 95% CI=1.003–1.156; p=0.042) and the presence of ≥1 donor APOL1 risk variant (HR=1.635; 95% CI=1.011–2.664; p=0.045) were independently associated with death-uncensored graft loss.
Conclusion
In this Brazilian cohort of living donor kidney transplantation, APOL1 risk variants were independently associated with inferior long-term graft survival. Notably, even the presence of a single APOL1 risk allele was associated with a significantly increased risk of death-uncensored graft loss.