Family history of ESKD shows no impact on long-term outcomes for African American donors
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Having a first-degree relative with a history of end-stage kidney disease did not appear to increase the risk for long-term kidney function decline or hypertension in African American kidney donors, according to study results.
“It is possible that increased risk of ESKD in [African American] donors may be partially explained by [apolipoprotein L1] APOL1 variants that are shared between donor and their related recipient,” Mariella Ortigosa-Goggins, MD, of the Miami Transplant Institute and the Katz Family Division of Nephrology and Hypertension at the Miller School of Medicine, University of Miami, and colleagues wrote. “Our current knowledge of impact of APOL1 variants on post-donation kidney function is limited and therefore APOL1 testing is not routinely used for donor selection. The NIH-initiated prospective study encompassing all live African American kidney donors in United States, APOL1 Long-term Kidney Transplantation Outcomes Network (APOLLO), is designed to address some of these issues. Until results of such studies are available, family history remains an important tool in donor selection.”
For the study, researchers included a cohort of 179 African American live kidney donors who donated between 1993 and 2010 (78% with family history of ESKD) and considered kidney function and hypertension (blood pressure 140/90 mmHg or greater or use of anti-hypertensive medications) at a median of 11 years after donation. Outcomes were compared between donors with and without a first-degree relative with ESKD, as well as between donors and non-donor controls.
“The groups were well matched on all characteristics except on socioeconomic variables,” the researchers wrote of the study population. “The non-donors were more likely to have health insurance, a higher level of education, and a higher income than the donors.”
When comparing donors based on family history of ESKD, researchers observed no difference in eGFR following donation (68 mL/min/1.73 m2 vs. 69 mL/min/1.73 m2) or in the presence of albuminuria.
For donors vs. non-donors, while no difference was found in annual eGFR change, the risk of hypertension was higher for donors (relative risk = 2.44). This increased risk was not associated with family history, though the researchers noted the differences in socioeconomic variables between the two groups could have affected this finding.
According to Ortigosa-Goggins and colleagues, the observed twofold greater risk for hypertension among African American donors compared with non-donors suggests regular follow-up appointments should be made to ensure adequate blood pressure management, especially because hypertension can impact long-term kidney function.
“The results of our study suggest that family history of ESKD in a first-degree relative should not be used to exclude African American live kidney donors,” the researchers concluded. “This crude metric of risk can be refined by specific relationship between the donor and recipient which better captures the possibility of sharing genetic risks, such as APOL1 genotype, (highest when the family member with ESKD is an identical twin, followed by full-sibling, offspring, parent, half-sibling, etc.).”
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