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Freedman BI, Julian BA, Pastan SO, Israni AK, Schladt D, Gautreaux MD, Hauptfeld V, Bray RA, Gebel HM, Kirk AD, Gaston RS, Rogers J, Farney AC, Orlando G, Stratta RJ, Mohan S, Ma L, Langefeld CD, Hicks PJ, Palmer ND, Adams PL, Palanisamy A, Reeves-Daniel AM, Divers J. Apolipoprotein L1 gene variants in deceased organ donors are associated with renal allograft failure. Am J Transplant 2015; 15:1615-22. [PMID: 25809272 PMCID: PMC4784684 DOI: 10.1111/ajt.13223] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/05/2014] [Accepted: 11/22/2014] [Indexed: 01/25/2023]
Abstract
Apolipoprotein L1 gene (APOL1) nephropathy variants in African American deceased kidney donors were associated with shorter renal allograft survival in a prior single-center report. APOL1 G1 and G2 variants were genotyped in newly accrued DNA samples from African American deceased donors of kidneys recovered and/or transplanted in Alabama and North Carolina. APOL1 genotypes and allograft outcomes in subsequent transplants from 55 U.S. centers were linked, adjusting for age, sex and race/ethnicity of recipients, HLA match, cold ischemia time, panel reactive antibody levels, and donor type. For 221 transplantations from kidneys recovered in Alabama, there was a statistical trend toward shorter allograft survival in recipients of two-APOL1-nephropathy-variant kidneys (hazard ratio [HR] 2.71; p = 0.06). For all 675 kidneys transplanted from donors at both centers, APOL1 genotype (HR 2.26; p = 0.001) and African American recipient race/ethnicity (HR 1.60; p = 0.03) were associated with allograft failure. Kidneys from African American deceased donors with two APOL1 nephropathy variants reproducibly associate with higher risk for allograft failure after transplantation. These findings warrant consideration of rapidly genotyping deceased African American kidney donors for APOL1 risk variants at organ recovery and incorporation of results into allocation and informed-consent processes.
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Affiliation(s)
- Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; Winston-Salem, NC,Center for Human Genomics & Personalized Medicine Research, Wake Forest School of Medicine; Winston-Salem, NC
| | - Bruce A. Julian
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham School of Medicine; Birmingham, AL
| | - Stephen O. Pastan
- Department of Medicine, Renal Division, Emory University School of Medicine; Atlanta, GA
| | - Ajay K. Israni
- Department of Medicine, Division of Nephrology, Hennepin County Medical Center, University of Minnesota; Minneapolis, MN,Minneapolis Medical Research Foundation; Minneapolis, MN
| | - David Schladt
- Minneapolis Medical Research Foundation; Minneapolis, MN
| | - Michael D. Gautreaux
- General Surgery & HLA Immunogenetics Lab, Wake Forest School of Medicine; Winston-Salem, NC
| | - Vera Hauptfeld
- Alabama Regional Histocompatibility Laboratory at UAB, University of Alabama at Birmingham School of Medicine; Birmingham, AL
| | - Robert A. Bray
- Department of Pathology & Lab Medicine; Emory School of Medicine; Atlanta, GA
| | - Howard M. Gebel
- Department of Pathology & Lab Medicine; Emory School of Medicine; Atlanta, GA
| | - Allan D. Kirk
- Department of General Surgery, Duke University School of Medicine; Durham, NC
| | - Robert S. Gaston
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham School of Medicine; Birmingham, AL
| | - Jeffrey Rogers
- Department of General Surgery, Wake Forest School of Medicine; Winston-Salem, NC
| | - Alan C. Farney
- Department of General Surgery, Wake Forest School of Medicine; Winston-Salem, NC
| | - Giuseppe Orlando
- Department of General Surgery, Wake Forest School of Medicine; Winston-Salem, NC
| | - Robert J. Stratta
- Department of General Surgery, Wake Forest School of Medicine; Winston-Salem, NC
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY
| | - Lijun Ma
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; Winston-Salem, NC
| | - Carl D. Langefeld
- Division of Public Health Sciences, Wake Forest School of Medicine; Winston-Salem, NC
| | - Pamela J. Hicks
- Center for Human Genomics & Personalized Medicine Research, Wake Forest School of Medicine; Winston-Salem, NC
| | - Nicholette D. Palmer
- Center for Human Genomics & Personalized Medicine Research, Wake Forest School of Medicine; Winston-Salem, NC
| | - Patricia L. Adams
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; Winston-Salem, NC
| | - Amudha Palanisamy
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; Winston-Salem, NC
| | - Amber M. Reeves-Daniel
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; Winston-Salem, NC
| | - Jasmin Divers
- Division of Public Health Sciences, Wake Forest School of Medicine; Winston-Salem, NC
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Piccoli GB, Attini R, Vigotti FN, Naretto C, Fassio F, Randone O, Restagno G, Todros T, Roccatello D. NEMO syndrome (incontinentia pigmenti) and systemic lupus erythematosus: a new disease association. Lupus 2012; 21:675-81. [PMID: 22235006 DOI: 10.1177/0961203311433140] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Congenital diseases are increasingly being recognised in adults because of clinical mimicry, variable clinical picture or rarity of the disease; pregnancy is a valuable diagnostic occasion. The present case is the first report of an association report between NEMO syndrome (an acronym of the mutated, non-functioning gene, NF-kB essential modulator), a rare X-linked disease, characterised by developmental anomalies, immunodepression and skin lesions, and systemic lupus erythematosus (SLE). A 35-year-old patient affected by SLE sought clinical advice in the 8th week of gestation. The diagnosis of SLE dated back to the age of 24, when multisystemic manifestations (pleuropericarditis, weight loss, alopecia, skin involvement, joint pain, kidney involvement) were observed. She had been treated with steroids since 1999; immunosuppressive drugs had been added for short periods. Developmental anomalies were present, including oligodontia, retinal problems, anomalies of the corpus callosum and pes planovalgus. Family history included multiple miscarriages, dental malformations and oligodontia and skin blistering in the first months of life. On these bases, incontinentia pigmenti (IP; or NEMO syndrome) was diagnosed and confirmed by genetic testing. The NEMO gene is implicated in immune deficiencies as well as in autoimmune diseases. This report may suggest a role for NF-kB essential modulator in the pathogenesis of SLE, in the context of the complex immunologic deficiencies increasingly associated with autoimmune diseases.
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Affiliation(s)
- G B Piccoli
- Nephrology Unit, Department of Clinical and Biological Sciences, San Luigi Hospital, Orbassano, University of Turin, Turin, Italy.
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