Health

What is a gene and what risks can it mean for a kidney transplant?


Transplant specialists, when evaluating a kidney coming from a donor, try to understand the possibility of a kidney failing after it is transplanted to a recipient. Their risk calculation considers factors including the donor’s age, height, weight, and history of diabetes. And, to the chagrin of some researchers, it also includes a donor race.

Kidneys of Black donors, living or dead, are automatically downgraded due to a higher risk of disease.

Some experts are now asking if there is a better way to evaluate kidneys from black donors, one that may rely more heavily on genetic screening than racing to assess the risk of failure.

The proposed genetic screening would check to see if donors carry two copies of variants in a gene, APOL1, that are closely associated with kidney disease. Because most Black donors don’t have those genetic variants, the experts argue, their kidneys shouldn’t automatically downgrade.

But before making that change, the researchers say they must determine if the kidneys of donors with risk variants of APOL1 are, in fact, more likely to fail.

The first hint came from a study by Dr. Barry Freedman, of Wake Forest University in North Carolina that involved 1,153 deceased donor kidney transplants performed at 113 different transplant programs. It found that kidneys from deceased donors with two risk variants were twice as likely to fail as quickly as kidneys from donors with one gene variant or none.

But that finding will need to be replicated in a larger research effort. It is being conducted with APOLLO, a large study funded by the National Institutes of Health, that evaluates living and deceased donors. Researchers are testing the APOL1 of kidney donors and tracking the fate of thousands of transplant patients who have received kidneys from black American donors at more than 97 transplant programs.

In the study, living donors can decide if they want to know the results of a genetic test and if they want their kidney recipient to know the results too. Medical privacy regulations forbid doctors from telling kidney transplant candidates if a living donor has variants without the donor’s consent.

Dr. Freedman said that regardless of the results of the study, an increasing number of transplant centers are hatching the idea of ​​genetic testing of people who want to donate kidneys.

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



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