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Clinical Utility of Standardized Genetic Testing in Kidney Transplant Candidate Evaluation
Yasar Caliskan1, Rengin Elsurer Afsar2, Fadee Abu Al Rub2
1Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN.
Transplantation Direct
|April 22, 2026
Summary
Genetic testing in kidney transplant candidates clarifies disease etiology, especially APOL1-mediated disease, and guides donor selection. It does not impact waitlisting or transplant rates.
Area of Science:
- Nephrology
- Genetics
- Transplant Surgery
Background:
- Genetic testing is increasingly utilized for kidney transplant (KT) candidates.
- Its impact on transplant outcomes requires further clarification.
Purpose of the Study:
- To assess the association between genetic test results and key steps in the KT process.
- To evaluate the clinical utility of genetic testing in KT candidate evaluation.
Main Methods:
- An observational cohort study of 270 KT candidates undergoing genetic testing.
- Comparison of waitlisting, transplantation rates, and post-transplant outcomes between candidates with and without positive genetic results.
Main Results:
- Positive genetic results were found in 38.5% of candidates, often associated with family history and younger age.
- Genetic testing identified APOL1-mediated disease in a significant proportion of candidates with unknown or hypertension-attributed end-stage kidney disease (ESKD).
- Waitlisting, transplantation rates, and post-transplant graft function did not differ between groups.
Conclusions:
- Genetic testing has high diagnostic yield in KT candidates, particularly for APOL1-associated kidney diseases.
- Testing informs disease etiology, counseling, and living donor assessment without negatively impacting transplant progression.
- Integrating genetic testing enhances precision medicine in kidney transplantation.
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