A National Survey of Transplant Surgeons and Nephrologists on Implementing Apolipoprotein L1 (APOL1) Genetic Testing Into Clinical Practice.
Elisa J Gordon, Catherine Wicklund, Jungwha Lee and 2 others
PMID 30541404WHAT IT FOUND
Most transplant physicians support APOL1 genetic testing for African American donors, but few use it.
They cite missing guidelines and data as barriers. Nurses delivering donor education should know that current practice relies heavily on clinical judgment rather than routine testing.
Key findings
01Only 4% of physicians who evaluate donors routinely use APOL1 testing, and 14% use it case-by-case, despite 63% planning to begin or continue using it within a year.
02The leading barriers to adoption were the lack of professional guidelines (52%) and the lack of prospective population data on donors (47%).
03In cases where testing was used, positive results (two risk variants) strongly or slightly dissuaded 79.2% of donors from proceeding, while negative results encouraged only 33.3%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study had a low participation rate, which may introduce nonresponse bias if physicians with greater knowledge of APOL1 were more likely to respond. The findings may not be generalizable to all members of the professional societies surveyed. The survey relied on self-reported attitudes and hypothetical scenarios, which may not perfectly predict actual clinical behavior. Providing a fact sheet to participants may have skewed their familiarity with APOL1 testing compared to real-world conditions where such background information is not uniformly available.
Declared interests
The study was supported by the National Institutes of Health (Extramural).
The easy way to misread this
Do not assume that APOL1 testing is a standard of care for all African American potential donors. The survey shows that while support for testing is high, actual use is very low (4% routine), and many physicians are waiting for guidelines before implementing it. Clinical decisions are currently driven by individual judgment and ethical concerns rather than a unified protocol.