APOL1 High-Risk Genotype Doubles Long-Term Kidney Decline in Black Donors, JAMA Internal Medicine Finds

The prospective analysis drew from the Scientific Registry of Transplant Recipients and measured post-donation eGFR trajectories plus proteinuria before and after nephrectomy. Absolute risk elevation reached 8.3 percentage points, with relative risk approximately 2.3; only one of three end-stage cases occurred in the high-risk group. These data refine earlier cross-sectional reports by quantifying cumulative incidence over nearly two decades.

Black patients comprise 30% of the kidney waitlist yet 8-14% of living donors. Current center policies often apply blanket caution to all Black candidates, suppressing donation rates. APOL1 genotyping could reclassify the 85% without high-risk alleles as standard-risk, expanding the pool while flagging the minority for individualized counseling. This precision layer addresses documented racial disparities without invoking race as a monolithic proxy.

Only 49% of major programs offered APOL1 testing in 2019. The new evidence supports guideline updates and payer coverage decisions. Next required studies are multicenter RCTs of disclosure protocols measuring donor recruitment rates, regret, and graft outcomes in recipients.