Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL.
University of Pennsylvania School of Medicine, Philadelphia, PA.
Ann Surg. 2018 Jun;267(6):1161-1168. doi: 10.1097/SLA.0000000000002174.
The aim of this study was to develop a novel chronic kidney disease (CKD) risk prediction tool for young potential living kidney donors.
Living kidney donor selection practices have evolved from examining individual risk factors to a risk calculator incorporating multiple characteristics. Owing to limited long-term data and lack of genetic information, current risk tools lack precision among young potential living kidney donors, particularly African Americans (AAs).
We identified a cohort of young adults (18-30 years) with no absolute contraindication to kidney donation from the longitudinal cohort study Coronary Artery Risk Development in Young Adults. Risk associations for CKD (estimated glomerular filtration rate <60 mL/min/1.73 m) were identified and assigned weighted points to calculate risk scores.
A total of 3438 healthy adults were identified [mean age 24.8 years; 48.3% AA; median follow-up 24.9 years (interquartile range: 24.5-25.2)]. For 18-year olds, 25-year projected CKD risk varied by ethnicity and sex even without baseline clinical and genetic abnormalities; risk was 0.30% for European American (EA) women, 0.52% for EA men, 0.52% for AA women, 0.90% for AA men. Among 18-year-old AAs with apolipoprotein L1 gene (APOL1) renal-risk variants without baseline abnormalities, 25-year risk significantly increased: 1.46% for women and 2.53% for men; among those with 2 APOL1 renal-risk variants and baseline abnormalities, 25-year risk was higher: 2.53% to 6.23% for women and 4.35% to 10.58% for men.
Young AAs were at highest risk for CKD, and APOL1 renal-risk variants drove some of this risk. Understanding the genetic profile of young AA potential living kidney donors in the context of baseline health characteristics may help to inform candidate selection and counseling.
本研究旨在为年轻的潜在活体肾脏捐献者开发一种新的慢性肾脏病（CKD）风险预测工具。
活体肾脏捐献者的选择实践已经从检查个体风险因素发展到纳入多个特征的风险计算器。由于缺乏长期数据和遗传信息，目前的风险工具在年轻的潜在活体肾脏捐献者中缺乏准确性，尤其是非裔美国人（AA）。
我们从纵向队列研究冠状动脉风险发展在年轻人中确定了一个没有绝对捐肾禁忌的年轻成年人队列（18-30 岁）。确定了 CKD（估计肾小球滤过率<60ml/min/1.73m）的风险关联，并为计算风险评分分配加权分数。
共确定了 3438 名健康成年人[平均年龄 24.8 岁；48.3%AA；中位随访 24.9 年（四分位距：24.5-25.2）]。对于 18 岁的人，即使没有基线临床和遗传异常，不同种族和性别的 25 年预测 CKD 风险也有所不同；欧洲裔美国女性的风险为 0.30%，欧洲裔美国男性的风险为 0.52%，非裔美国女性的风险为 0.52%，非裔美国男性的风险为 0.90%。在没有基线异常的载脂蛋白 L1 基因（APOL1）肾风险变异的 18 岁 AA 中，25 年风险显著增加：女性为 1.46%，男性为 2.53%；在有 2 个 APOL1 肾风险变异和基线异常的人群中，25 年风险更高：女性为 2.53%至 6.23%，男性为 4.35%至 10.58%。
年轻的 AA 患 CKD 的风险最高，APOL1 肾风险变异导致了部分风险。了解年轻 AA 潜在活体肾脏捐献者的遗传特征及其与基线健康特征的关系，可能有助于为候选者的选择和咨询提供信息。
