About the APOL1 genetic test

Two renal-risk variants in the apolipoprotein L1 gene (APOL1), termed G1 and G2, are present in a large percentage of African American organ donors and kidney transplant recipients. Upon receiving deceased donor kidneys from African Americans with two APOL1 renal-risk variants, transplant recipients experience earlier allograft failure. Moreover, individuals who possess two APOL1 renal-risk variants are themselves more susceptible to developing nephropathy. These observations support testing for APOL1 renal-risk variants in deceased African American kidney donors to improve the organ allocation process. Determining APOL1 renal-risk variant status could better inform physicians and kidney transplant recipients about the projected outcomes of transplanted kidneys.

Wake Forest Baptist Health, under the scientific leadership of Barry I. Freedman, MD, section chief of nephrology, has developed and now offers APOL1 genetic testing with results within 7 days of receipt for potential live donors and patients at risk. Contact our Immunodiagnostics Laboratory to discuss same-day results for deceased donors. Speedy results enable physicians to make timely decisions based on the findings of the test.

• Clinical Laboratory Improvement Amendments (CLIA)

How the APOL1 genetic test works

The APOL1 test is an inexpensive and convenient personalized genetic test that reports on risk for non-diabetic nephropathy and more rapid failure of transplanted kidneys. The test may inform physicians about optimal allocation of donor kidneys and lead to improved patient care and outcomes. Genetic testing for potential live donors and patients at risk consists of a blood test. DNA is extracted from the sample, then amplified, sequenced, and assembled into a readable format for the physician.

Analysis of the sample can determine if a kidney donor (potential live kidney donor or deceased kidney donor) or a patient inherited two APOL1 gene renal-risk variants that contribute to poorer renal allograft survival after transplantation. Genetic testing might help determine if a donor kidney carries greater risk for renal complications after transplantation, such as a higher serum creatinine concentration or earlier allograft failure.

Results of APOL1 genetic testing and why you should use it

APOL1 genetic testing can help you make informed decisions about how to manage future risks of allograft failure in your renal transplant patients. For example, if it is determined that a donor kidney is at greater risk for shortened allograft survival based on presence of two APOL1 renal-risk variants, rapid re-assessment of allocation of the kidney may be advisable.

Also, if you have patients with kidney disease and you determine that they possess two APOL1 renal-risk variants, they may be at increased risk for developing progressive renal failure.

Test results can help you develop an individualized plan of care for your patients. Results can be of great value to family members, including those considering donating a kidney. Counseling sessions are recommended to fully inform patients – before and after genetic testing – and may contribute to improved outcomes.

References

Freedman, Barry I., et al. “APOL1 Genotype and Kidney Transplantation Outcomes From Deceased African American Donors.” Transplantation (2015).

U.S. Renal Data System, USRDS 2012 Annual Data Report, Vol 1: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. 2012

Reeves‐Daniel, Amber M., et al. “The APOL1 gene and allograft survival after kidney transplantation.” American Journal of Transplantation 11.5 (2011): 1025-1030.

Freedman, B. I., et al. “Apolipoprotein L1 gene variants in deceased organ donors are associated with renal allograft failure.” American Journal of Transplantation 15.6 (2015): 1615-1622.