Dataset Information

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

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.

SUBMITTER: Freedman BI

PROVIDER: S-EPMC7056919 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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<i>APOL1</i> Long-term Kidney Transplantation Outcomes Network (APOLLO): Design and Rationale.

Freedman Barry I BI Moxey-Mims Marva M MM Alexander Amir A AA Astor Brad C BC Birdwell Kelly A KA Bowden Donald W DW Bowen Gordon G Bromberg Jonathan J Craven Timothy E TE Dadhania Darshana M DM Divers Jasmin J Doshi Mona D MD Eidbo Elling E Fornoni Alessia A Gautreaux Michael D MD Gbadegesin Rasheed A RA Gee Patrick O PO Guerra Giselle G Hsu Chi-Yuan CY Iltis Ana S AS Jefferson Nichole N Julian Bruce A BA Klassen David K DK Koty Patrick P PP Langefeld Carl D CD Lentine Krista L KL Ma Lijun L Mannon Roslyn B RB Menon Madhav C MC Mohan Sumit S Moore J Brian JB Murphy Barbara B Newell Kenneth A KA Odim Jonah J Ortigosa-Goggins Mariella M Palmer Nicholette D ND Park Meyeon M Parsa Afshin A Pastan Stephen O SO Poggio Emilio D ED Rajapakse Nishadi N Reeves-Daniel Amber M AM Rosas Sylvia E SE Russell Laurie P LP Sawinski Deirdre D Smith S Carrie SC Spainhour Mitzie M Stratta Robert J RJ Weir Matthew R MR Reboussin David M DM Kimmel Paul L PL Brennan Daniel C DC

Kidney international reports 20191213 3

<h4>Introduction</h4>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 (<i>APOL1</i>). 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 <i>APOL1</i> Long-term Kidney Transplantation O ...[more]

PMID: 32154449

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Project description:Rationale & objectiveSepsis-associated acute kidney injury often leads to acute kidney disease (AKD), predisposing patients to long-term complications such as chronic kidney disease (CKD), kidney failure with replacement therapy (KFRT), or mortality. Risk stratification of patients with AKD represents an opportunity to assist with prognostication of long-term kidney complications.Study designSingle-center retrospective cohort.Setting & participants6,290 critically ill patients admitted to the intensive care unit with severe sepsis or septic shock. Patients were separated into cohorts based on incident acute kidney injury or not, and survivors identified who were alive and free of KFRT up to 90 days.PredictorsAKD stage (0A, 0C, or ≥1) using the last serum creatinine concentration available by discharge or up to 90 days postdischarge.OutcomeTime to development of incident CKD, progression of CKD, KFRT, or death.Analytical approachMultivariable Cox proportional hazards models.ResultsPatients surviving kidney injury associated with sepsis often fail to return to baseline kidney function by discharge: 577/1,231 (46.9%) with stage 0C or 1 or greater AKD. AKD stage was significantly associated with the composite primary outcome. Stages 0C AKD and 1 or greater AKD were significantly and progressively associated with the primary outcome when compared with stage 0A AKD (adjusted HR [aHR], 1.74; 95% CI, 1.32-2.29, and aHR, 3.25; 95% CI, 2.52-4.20, respectively). Additionally, stage 1 or greater AKD conferred higher risk above stage 0C AKD (aHR, 1.87; 95% CI, 1.44-2.43). CKD incidence or progression and KFRT, more so than mortality, occurred with greater frequency in higher stages of AKD.LimitationsRetrospective design, single center, exclusion of patients with KFRT within 90 days of discharge, potential ascertainment bias, and inability to subclassify above AKD stage 1.ConclusionsRisk stratification using recommended AKD stages at hospital discharge or shortly thereafter associates with the development of long-term kidney outcomes following sepsis-associated acute kidney injury.

Dataset Information

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

Publications

<i>APOL1</i> Long-term Kidney Transplantation Outcomes Network (APOLLO): Design and Rationale.

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