Torque teno virus for risk stratification of graft rejection and infection in kidney transplant recipients - A prospective observational trial
Measuring blood levels of the harmless torque teno virus reflected how strongly a kidney transplant patient was immunosuppressed: higher levels predicted infection while lower levels predicted rejection, suggesting a simple test to fine-tune anti-rejection drugs.
Background
The ubiquitous, nonpathogenic torque teno virus replicates in proportion to host immunosuppression. This prospective trial evaluated whether quantifying TTV load could stratify risk of graft rejection and infection in kidney transplant recipients.
Study design
386 consecutive kidney transplant recipients underwent longitudinal per-protocol monitoring of plasma TTV load by PCR for 12 months post-transplant; TTV load after month 3 was analyzed against subsequent biopsy-diagnosed rejection and infection within the first year.
Key findings
Each log increase in TTV load decreased rejection odds by 22% (OR 0.78) and increased infection odds by 11% (OR 1.11). TTV was quantifiable a median of 14 days before rejection and 27 days before infection. A load between 1x10^6 and 1x10^8 copies/mL was defined as the optimal range to minimize both risks.
Clinical implications
TTV load is a measurable surrogate of net immunosuppression that anticipates rejection and infection, supporting interventional trials of TTV-guided immunosuppression to personalize dosing after kidney transplantation.
Category
Transplant
Source
American Journal of Transplantation
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