The APOL1 gene and kidney transplantation: a review article

Chronic kidney disease (CKD) is a global public health problem and kidney transplantation is the treatment of choice for patients with stage 5 (G5) CKD. Kidney transplant survival at the end of the first year exceeds 95%, and at 5 years, it approaches 90%. However, the decline in the estimated glomerular filtration rate (eGFR) over the years remains a challenge. The rate of eGFR decline is attributed to several factors and has recently been attributed to the presence of APOL1 gene variants.

The risk variants G1 and G2 of the APOL1 gene are related to CKD. Evidence suggests that kidneys from deceased donors carrying APOL1 risk variants have worse kidney graft survival. The presence of risk variants in living donors also confers worse long-term outcomes after donation. Novel therapies targeted to inhibit APOL1 protein function have not yet been tested in the transplant population. Proteomic studies continue to advance, using increasingly refined techniques to analyze APOL1 isoforms, their receptors, metabolites, agonists, and potential blockers.

Risk variants have a significant impact on the understanding of CKD and kidney transplantation. Research on these variants in potential living donors should better guide donor selection and decision-making regarding donation.