Apolipoprotein L1 kidney risk variants linked to post-transplant collapsing glomerulopathy
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Key takeaways:
- Collapsing glomerulopathy developed at a median 269 days post-transplant in the study cohort.
- Overall, 59% of patients had allograft failure after collapsing glomerulopathy developed.
PHILADELPHIA — In patients with post-transplant collapsing glomerulopathy, a similar portion of donors had one or two apolipoprotein L1 kidney risk variants, whereas few had none.
“Collapsing glomerulopathy is [an] underdiagnosed complication of the kidney allograft,” Ibrahim Batal, MD, of the Columbia University Irving Medical Center in New York, said at the American Transplant Congress. “[It] is rare, encountered more often in recipients of kidneys from Black donors and is associated with [poor prognosis].”
Researchers studied 46 patients who received kidney allografts from donors who were Black; the recipients later developed collapsing glomerulopathy. The goal of the study was to highlight the relationship between hereditary and immune factors of the condition in renal allografts.
All donors were Black, 55% of recipients were Black and 41% were women, Batal said in a presentation, and APOL1 genotyping was available for 38 donors.
According to the findings, collapsing glomerulopathy developed at a median 269 days post-transplant and 59% of patients had allograft failure at a median 269 days after collapsing glomerulopathy developed. Overall, 43% of genotyped Black donors had two APOL1 kidney risk variants, 46% had one and 11% had none, Batal and colleagues noted.
The presence of two kidney risk variants in the donor was linked to worse allograft survival vs. one kidney risk variant.
Findings also showed that the development of collapsing glomerulopathy was associated with upregulation of inflammatory pathways, including type II interferon.
“There is apparent dose effects of donor APOL1 kidney risk variants on the development of post-transplant collapsing glomerulopathy,” Batel said.
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Batal I, et al. Poster 1081. Presented at: American Transplant Congress; June 1-5, 2024; Philadelphia.
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