A new study finds that Black living kidney donors with high-risk APOL1 gene variants face more than double the risk of significant kidney dysfunction nearly two decades after donation. Researchers say all Black donor candidates should be screened for this genotype — not to exclude them, but to better inform their decision-making. The findings, published in JAMA Internal Medicine, could one day replace race-based risk algorithms with more precise genetic data.
A landmark study published in JAMA Internal Medicine found that Black living kidney donors carrying high-risk APOL1 genotypes were more than twice as likely to develop significant kidney impairment — defined as an eGFR below 45 mL/min/1.73 m² — nearly two decades after donation, compared to those without these variants. The APOL1 G1 and G2 gene variants occur almost exclusively in people of African or Caribbean ancestry and are already known to raise the risk of chronic kidney disease (CKD) and kidney failure in other settings.
The LETO study followed 445 Black and 208 White living kidney donors, with research visits conducted a median of 18.5 years post-donation. Among Black donors, 15.3% carried high-risk genotypes — and their rate of reaching the primary kidney impairment threshold was 14.7% vs. 6.4% for those without the variants. Lead author Dr. Chi-yuan Hsu argues that APOL1 testing could eventually replace race as a variable in donor risk algorithms, offering more precise, individualized risk stratification.
Key Takeaways:
Why it matters: With Black patients already facing structural disadvantages in accessing kidney transplants, APOL1 screening could actually expand the donor pool by identifying low-risk individuals — while ensuring high-risk donors receive proper counseling and informed consent.
