A functional polymorphism in the donor associates with long-term graft survival after kidney transplantation.

Background: Improvement of long-term outcomes in kidney transplantation remains one of the most pressing challenges, yet drug development is stagnating. Human genetics offers an opportunity for much-needed target validation in transplantation. Conflicting data exist about the effect of transforming growth factor-beta 1 (TGF-β1) on kidney transplant survival, since TGF-β1 has pro-fibrotic and protective effects. We investigated the impact of a recently discovered functional polymorphism on kidney graft survival.

Methods: We performed an observational cohort study analysing recipient and donor DNA in 1271 kidney transplant pairs from the University Medical Centre Groningen in The Netherlands, and associated a low-producing polymorphism (rs1800472-C > T) with 5-, 10- and 15-year death-censored kidney graft survival.

Results: Donor genotype frequencies of rs1800472 in differed significantly between patients with and without graft loss (P = 0.014). Additionally, the low-producing polymorphism in the donor was associated with an increased risk of graft loss following kidney transplantation (hazard ratio = 2.12 for the T-allele; 95% confidence interval 1.18-3.79; P = 0.012). The incidence of graft loss within 15 years of follow-up was 16.4% in the CC-genotype group and 31.6% in the CT-genotype group. After adjustment for transplant-related covariates, the association between the polymorphism in the donor and graft loss remained significant. In contrast, there was no association between the polymorphism in the recipient and graft loss.

Conclusions: Kidney allografts possessing a low-producing polymorphism have a higher risk of late graft loss. Our study adds to a growing body of evidence that TGF-β1 is beneficial, rather than harmful, for kidney transplant survival.