The nonpathogenic and ubiquitous torque teno virus (TTV) is associated with immunosuppression in solid organ transplant recipients. Studies in kidney transplant patients proposed TTV quantification for risk stratification of graft rejection and infection. In this prospective trial (DRKS00012335) 386 consecutive kidney transplant recipients were subjected to longitudinal per‐protocol monitoring of plasma TTV load by polymerase chain reaction for 12 months posttransplant. TTV load peaked at the end of month 3 posttransplant and reached steady state thereafter. TTV load after the end of month 3 was analyzed in the context of subsequent rejection diagnosed by indication biopsy and infection within the first year posttransplant, respectively. Each log increase in TTV load decreased the odds for rejection by 22% (odds ratio [OR] 0.78, 95% confidence interval [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). TTV was quantified at a median of 14 days before rejection was diagnosed and 27 days before onset of infection, respectively. We defined a TTV load between 1 × 10⁶ and 1 × 10⁸ copies/mL as optimal range to minimize the risk for rejection and infection. 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.

中文翻译：

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Torque teno 病毒用于肾移植受者移植物排斥和感染的风险分层——一项前瞻性观察试验。

非致病性和无处不在的力矩肌腱病毒 (TTV) 与实体器官移植受者的免疫抑制有关。对肾移植患者的研究提出了 TTV 量化用于移植物排斥和感染的风险分层。在这项前瞻性试验 (DRKS00012335) 中，连续 386 名肾移植受者在移植后 12 个月内通过聚合酶链反应按方案纵向监测血浆 TTV 负荷。TTV 负荷在移植后第 3 个月末达到峰值，此后达到稳定状态。第 3 个月结束后的 TTV 负荷分别在移植后第一年内通过适应症活检和感染诊断的后续排斥反应的背景下进行分析。TTV 负荷每增加一个对数，拒绝几率就会降低 22%（优势比 [OR] 0.78，P = .027) 并使感染几率增加 11%（OR 1.11，95% CI 1.06-1.15；P < .001）。TTV 分别在诊断排斥反应前 14 天和感染开始前 27 天的中位数进行量化。^{我们将 1 × 10 6}和 1 × 10 ⁸拷贝/mL之间的 TTV 负荷定义为最佳范围，以最大限度地降低排斥和感染的风险。这些数据支持启动一项干预性试验，以评估 TTV 引导的免疫抑制在减少肾移植受者感染和移植物排斥反应方面的功效。