APOL1 Long-term Kidney Transplantation Outcomes Network (APOLLO): Design and Rationale

• Type of Material: Article
• Authors: Barry I. Freedman, Wake Forest School of Medicine; Marva M. Moxey-Mims, Childrens National Health System; Amir A. Alexander, Wake Forest School of Medicine; Brad C. Astor, University of Wisconsin; Kelly A. Birdwell, Vanderbilt University; Donald W. Bowden, Wake Forest School of Medicine; Gordon Bowen, Lifebanc; Jonathan Bromberg, University of Maryland; Kenneth Newell, Emory University; Stephen Pastan, Emory University
• Language: English
• Date: 2020-03-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Final Published Version
• Copyright Statement: © 2019 International Society of Nephrology
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ekir.2019.11.022
• Title of Journal or Parent Work: KIDNEY INTERNATIONAL REPORTS
• Volume: 5
• Issue: 3
• Start Page: 278
• End Page: 288
• Grant/Funding Information: Support was received from the following National Institutes of Health grants (recipient’s affiliations included): 5U01DK116041 (BIF, DMR, RJS, and DWB; Wake Forest School of Medicine, Winston-Salem, North Carolina, USA), 5U01DK116043 (C-yH and MP; University of California, San Francisco, San Francisco, California, USA), 5U01DK116099 (SOP and KAN; Emory University School of Medicine, Atlanta, Georgia, USA), 5U01DK116040 (AMR-D, BIF, and RAG; Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA), 5U01DK116093 (KAB, Vanderbilt University, Nashville, Tennessee, USA), 5U01DK116042 (DCB and KLL; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Saint Louis University School of Medicine, St. Louis, Missouri, USA), 5U01DK115997 (BAJ and RBM; University of Alabama School of Medicine in Birmingham, Birmingham, Alabama, USA), 5U01DK116095 (JB and MRW; University of Maryland School of Medicine, Baltimore, Maryland, USA), 5U01DK116097 (EDP and MDD; Cleveland Clinic, Cleveland, Ohio, USA; University of Michigan School of Medicine, Ann Arbor, Michigan, USA), 5U01DK116066 (SM and DS; Columbia University, New York, New York, USA; University of Pennsylvania, Philadelphia, Pennsylvania, USA), 5U01DK116092 (BCA, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA), 5U01DK116101 (AF, GG, and MO-G; University of Miami Miller School of Medicine, Miami, Florida, USA), 5U01DK116102 (SER, Joslin Diabetes Center, Boston, Massachusetts, USA), 5U01DK116100 (BM and DMD; Icahn School of Medicine at Mount Sinai, New York, New York, USA; Weill Cornell Medicine, New York, New York, USA), R01 DK120551 (APOLLO ancillary study) (C-yH, MP, and KLL; University of California, San Francisco, San Francisco, California, USA; Saint Louis University School of Medicine, St. Louis, Missouri, USA), and R01 MD014161 (APOLLO ancillary study) (James Dubois, SM; Washington University School of Medicine, St. Louis, Missouri, USA; Columbia University, New York, New York, USA).
• Keywords: GENE VARIANTS; graft failure; Science & Technology; REPLACING RACE; APOL1; RISK; chronic kidney disease; outcomes; GENOTYPE; SAMPLE-SIZE FORMULA; SURVIVAL; Life Sciences & Biomedicine; African Americans; Urology & Nephrology; kidney transplantation; DECEASED DONOR KIDNEYS
• Research Categories: Health Sciences, Medicine and Surgery; Sociology, Ethnic and Racial Studies; Biology, Genetics

Abstract

Introduction: Much of the higher risk for end-stage kidney disease (ESKD) in African American individuals relates to ancestry-specific variation in the apolipoprotein L1 gene (APOL1). Relative to kidneys from European American deceased-donors, kidneys from African American deceased-donors have shorter allograft survival and African American living-kidney donors more often develop ESKD. The National Institutes of Health (NIH)–sponsored APOL1 Long-term Kidney Transplantation Outcomes Network (APOLLO) is prospectively assessing kidney allograft survival from donors with recent African ancestry based on donor and recipient APOL1 genotypes. Methods: APOLLO will evaluate outcomes from 2614 deceased kidney donor-recipient pairs, as well as additional living-kidney donor-recipient pairs and unpaired deceased-donor kidneys. Results: The United Network for Organ Sharing (UNOS), Association of Organ Procurement Organizations, American Society of Transplantation, American Society for Histocompatibility and Immunogenetics, and nearly all U.S. kidney transplant programs, organ procurement organizations (OPOs), and histocompatibility laboratories are participating in this observational study. APOLLO employs a central institutional review board (cIRB) and maintains voluntary partnerships with OPOs and histocompatibility laboratories. A Community Advisory Council composed of African American individuals with a personal or family history of kidney disease has advised the NIH Project Office and Steering Committee since inception. UNOS is providing data for outcome analyses. Conclusion: This article describes unique aspects of the protocol, design, and performance of APOLLO. Results will guide use of APOL1 genotypic data to improve the assessment of quality in deceased-donor kidneys and could increase numbers of transplanted kidneys, reduce rates of discard, and improve the safety of living-kidney donation.