A gene variant common in people of African ancestry may significantly raise the risk of long-term kidney problems after donation. A new study found that Black living kidney donors with a high-risk APOL1 genotype were more than twice as likely to have significantly reduced kidney function nearly two decades post-donation. Researchers are now calling for routine APOL1 screening as part of the donor evaluation process.
A new study published in JAMA Internal Medicine adds compelling evidence that APOL1 genotyping should become a standard part of the living kidney donor screening process — at least for Black donor candidates. The LETO study followed 445 Black living kidney donors for a median of 18.5 years post-donation and found that those carrying high-risk APOL1 genotypes (two copies of the G1 or G2 variants) faced significantly worse long-term kidney outcomes than those without.
Researchers from UCSF and colleagues used the Scientific Registry of Transplant Recipients to identify donors and conducted home-based research visits between 2020 and 2024 to assess kidney function. The findings showed that high-risk APOL1 carriers were more than twice as likely to have severely reduced kidney function and nearly four times as likely to have severe protein leakage in the urine.
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Why it matters: Rather than treating all Black donor candidates as uniformly high-risk, APOL1 genotyping could actually expand the donor pool by reassuring the majority — who carry low-risk genotypes — that they're safe to donate, while flagging the smaller subset who may need more careful counseling.
