*Purpose: The non-pathogenic and ubiquitous Torque Teno virus (TTV) is associated with immunosuppression in solid organ transplant recipients. This trial was designed to assess the potential of TTV load for risk prediction of both, infection and rejection in the first year after transplantation. The objective of this trial was to provide TTV cut-off level to define an optimal TTV range as a basis for a randomised controlled interventional trial to test the efficacy of TTV-guided immunosuppression.

*Methods: In this prospective trial (DRKS00012335) 386 consecutive kidney transplant recipients were subjected to longitudinal per protocol TTV monitoring. TTV copies/mL peripheral blood plasma were assessed by rt-PCR. In total 3265 TTV measurements were taken and 71 biopsy proven graft rejections and 472 clinically relevant infections were documented in the first year post-transplant. After reaching steady state at the end of post-transplant month 3, TTV load was analyzed in the context of subsequent rejection and infection.

*Results: TTV was quantified at a median of 14 days before rejection diagnosis and 46 days before infection onset. Each log increase in TTV load decreased the odds for rejection by 22% (OR 0.78, 95% CI 0.62-0.97; P = .027) and increased the odds for infection by 11% (OR 1.11, 95% CI 1.06-1.15; P < .001). A TTV load between 1x10⁶ and 1×10⁸ copies/mL was defined as optimal range to minimize the risk for rejection and infection.

*Conclusions: These data support the initiation of an interventional trial assessing the efficacy of TTV-guided immunosuppression to reduce infection and graft rejection in kidney transplant recipients.

« Back to 2020 American Transplant Congress