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J Infect Dis. 2019 Jan 18. doi: 10.1093/infdis/jiz039. [Epub ahead of print]

Torque Teno Virus for Risk Stratification of Acute Biopsy-proven Alloreactivity in Kidney Transplant Recipients.

Author information

1
Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Vienna, Austria.
2
Division of Transplant Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria.
3
Department of Emergency Medicine, Medical University Vienna, Vienna, Austria.
4
Center of Virology, Medical University Vienna, Vienna, Austria.
5
Department of Pathology, Medical University Vienna, Vienna, Austria.
6
Division of Medical and Chemical Laboratory Diagnostics, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria.

Abstract

Background:

Drug-induced immunosuppression in kidney transplant recipients is crucial to prevent allograft rejection, but increases risk for infectious disease. Immunologic monitoring to tailor immunosuppressive drugs might prevent alloreactivity and adverse effects simultaneously. The apathogenic Torque Teno virus (TTV) reflects the immunocompetence of its host and might act as a potential candidate for a holistic monitoring.

Methods:

We screened all 1010 consecutive patients from the prospective 'Vienna kidney transplant cohort study' for availability of allograft biopsies and adequately stored sera for TTV quantification by polymerase chain reaction.

Results:

Patients with acute biopsy-proven alloreactivity according to BANFF classification (n=33) showed lower levels of TTV in the peripheral blood compared to patients without rejection (n=80) at a median of 43 days before the biopsy. The risk for alloreactivity decreased by 10% per log level of TTV copies/mL (risk ratio 0.90; 95% confidence interval, 0.84 - 0.97; P = 0.005). TTV levels above 1x106 copies/mL exclude rejection with a sensitivity of 94%. Multivariable generalized linear modeling suggests an independent association between TTV level and alloreactivity.

Conclusions:

TV is a prospective biomarker for risk stratification of acute biopsy-proven alloreactivity in kidney transplant recipients and might be a potential tool to tailor immunosuppressive drug therapy.

PMID:
30668796
DOI:
10.1093/infdis/jiz039

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