Torque teno virus for risk stratification of graft rejection and infection in kidney transplant recipients-A prospective observational trial

Am J Transplant. 2020 Aug;20(8):2081-2090. doi: 10.1111/ajt.15810. Epub 2020 Mar 8.


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.

Keywords: biomarker; complication: infectious; immunosuppression/immune modulation; infection and infectious agents-viral; infectious disease; kidney transplantation/nephrology; monitoring: immune; rejection; translational research/science.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • DNA, Viral / genetics
  • Graft Rejection / diagnosis
  • Graft Rejection / etiology
  • Humans
  • Kidney Transplantation* / adverse effects
  • Prospective Studies
  • Risk Assessment
  • Torque teno virus* / genetics
  • Viral Load


  • DNA, Viral