(CCs) to recruit and follow participants. APOLLO focuses on key aspects of the 2019 Presidential Executive Order on Kidney Care, addressing improved care of the African American population and emphasizing increasing rates of transplantation, improving efficiency of transplantation, and streamlining organ procurement processes (https:// www.whitehouse.gov/briefings-statements/remarkspresident-trump-signing-executive-order-advancingamerican-kidney-health/). Implementing the APOLLO protocol across 260 kidney transplant programs, 58 OPOs, and 66 histocompatibility laboratories is challenging; OPOs and histocompatibility laboratories participate voluntarily. Figure 1 displays the APOLLO organizational chart and Table 1 lists the 17 APOLLO CCs and co-CCs, with principal investigators. The APOLLO Steering Committee (SC) consists of representatives from NIH, an external study chair, chair of the community advisory council (CAC), the Wake Forest School of Medicine SDRC and principal investigators at 13 APOLLO CCs.12 Leadership of UNOS and Association of Organ Procurement Organizations (AOPO) participate (nonvoting members). BACKGROUND APOLLO is an observational study prospectively evaluating outcomes after kidney transplantation from deceased- and living-donors with recent African ancestry.11 APOLLO includes donors with self-reported or family-reported African American, Hispanic black, Afro-Caribbean, and African ancestry. Clinical data, DNA, serum, and urine from kidney donors and recipients of their kidneys are collected. To prevent alterations in clinical practice and minimize variability, APOL1 genotypes will be determined after recruitment ends. UNOS will provide outcomes data. Additional information is on the APOLLO Web site: http:// TheApolloNetwork.org. The primary objective of APOLLO is determining whether the presence of APOL1 renal-risk genotypes in deceased-donors is associated with death-censored renal allograft survival. Secondary objectives include the following: defining whether the presence of APOL1 high-risk genotypes in kidney donors is associated with poorer kidney function or greater proteinuria after transplantation; defining whether the presence of APOL1 high-risk genotypes is associated with poorer kidney outcomes in living-kidney donors after nephrectomy; and Figure 1. APOL1 Long-term Kidney Transplantation Outcomes Network (APOLLO) organizational chart (developed using clker.com free clipart; http://www.clker.com/clipart-blank-gray-usa-map-white-lines-1.html). NIH, National Institutes of Health; OPO, organ procurement organization. CLINICAL RESEARCH BI Freedman et al.: APOLLO Study Design and Rationale 280 Kidney International Reports (2020) 5, 278–288 identifying modifying factors that increase susceptibility to shortened allograft survival, reduced kidney allograft function, or association with greater proteinuria in recipients of kidneys from APOL1 highrisk genotype donors, under the assumption that donor APOL1 high-risk genotypes are associated with poorer kidney function in recipients of renal allografts. APOLLO results could prompt a revision of the current formula to calculate the KDRI by replacing the ethnicity/race component with APOL1 genotype.13,14 This refinement could reduce discard of APOL1 lowrisk genotype deceased-donor kidneys, leading to more transplants, improved quality of life for recipients, and reduced health care costs. Despite consistent retrospective results, data from a wellpowered national prospective study would provide stronger justification for implementing universal APOL1 genotyping in deceased-donors.15 Clarification of the role of APOL1 genotyping in potential living-donors is also urgently needed. Although recommending APOL1 genotyping be considered in the living-donor candidate evaluation, the 2017 Kidney Disease: Improving Global Outcomes Guideline for the Evaluation and Care of Living Donors identified the need to define the role of APOL1 genotyping in the evaluation of donor candidates with recent African ancestry as a key research priority.16 APOLLO and its ancillary studies address this call for additional evidence. ORGANIZATION OF KIDNEY TRANSPLANT PROGRAMS IN APOLLO APOLLO aims to enroll all eligible kidney donors and kidney transplant recipients from U.S. transplant programs. This effort includes 260 academic and community-based programs with kidneys recovered from 58 OPOs (Figure 1). Approximately half of these programs perform 90% of kidney transplants eligible for APOLLO. To foster universal participation, the SDRC aligned each of the 13 CCs with multiple transplant programs to include all programs. CC principal investigators are working with medical directors and physicians at their assigned programs. To date, a small number of kidney transplant programs (each anticipated to perform The effect of a kidney transplant on a recipient extends beyond the restoration of kidney function. However, there is limited qualitative analysis of recipient perspectives on life following transplantation, particularly in the United States. To understand the full patient experience, it is necessary to understand recipient views