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What the genes and their risks may mean for kidney transplant 2022

Transplant specialists, when evaluating kidneys that come from donors, try to find out how likely the kidney is to fail after it is transplanted into the recipient. Their risk calculation considers factors including the donor’s age, height, weight and history of diabetes. And, to the dismay of some researchers, it also includes the race of the donor.

The kidneys of deceased black donors are automatically downgraded as high risk.

Some experts are now asking whether there is a better way to evaluate kidneys from black donors, which may rely more on genetic screening rather than race to assess the risk of failure.

The proposed genetic investigation will examine whether donors have two copies of variants in a gene, APOL1, that is strongly associated with kidney disease. Because most black donors do not have those genetic variants, experts argue that their kidneys should not automatically be downgraded.

But before that change can be established, the researchers say they need to determine whether, in fact, donors at risk for APOL1 are more likely to have kidney failure.

The first sign came from Wake Forest University School of Medicine in North Carolina, Dr. Barry Friedman, which included 1,153 deceased donor kidney transplants performed in 113 different transplant programs. It found that the kidneys of deceased donors with two risk types were twice as likely to fail more rapidly than those from donors who had either one gene variant or none.

But that finding would need to be replicated in a larger research effort. This is in line with Apollo, a larger study sponsored by the National Institutes of Health to assess living and deceased donors. Study researchers are testing kidney donors for APOL1 and following the fate of thousands of transplant patients who have received kidneys from black American donors in more than 97 transplant programs.

In the study, living donors can decide whether they want to learn the result of their genetic test and if they want the recipient of their kidney to know the result as well. Medical confidentiality rules forbid doctors from telling kidney transplant candidates if a living donor has the variant without the donor’s consent.

Dr. Friedman said that whatever the results of the research, more transplant centers are pushing the idea of ​​genetic testing for people who want to donate kidneys.

Until recently, he said, “many transplant centers said they didn’t want to talk about it.”

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