title: Torque Teno Virus Load-Inverse Association With Antibody-Mediated Rejection After Kidney Transplantation.
abstract: Antibody-mediated rejection (AMR) represents one of the cardinal causes of late allograft loss after kidney transplantation, and there is great need for noninvasive tools improving early diagnosis of this rejection type. One promising strategy might be the quantification of peripheral blood DNA levels of the highly prevalent and apathogenic Torque Teno virus (TTV), which might mirror the overall level of immunosuppression and thus help determine the risk of alloimmune response.
  
  
  
  To assess the association between TTV load in the peripheral blood and AMR, 715 kidney transplant recipients (median, 6.3 years posttransplantation) were subjected to a systematical cross-sectional AMR screening and, in parallel, TTV quantification.
  
  
  
  Eighty-six of these recipients had donor-specific antibodies and underwent protocol biopsy, AMR-positive patients (n = 46) showed only 25% of the TTV levels measured in patients without AMR (P = 0.003). In a generalized linear model, higher TTV levels were associated with a decreased risk for AMR after adjustment for potential confounders (risk ratio 0.94 per TTV log level; 95% confidence interval 0.90-0.99; P = 0.02).
  
  
  
  Future studies will have to clarify whether longitudinal assessment of TTV load might predict AMR risk and help guide the type and intensity of immunosuppression to prevent antibody-mediated graft injury.
authors.affiliation: 1 Division of Nephrology and Dialysis, Department of Medicine III, Medical University Vienna, Austria. 2 Department of Virology, Medical University of Vienna, Austria. 3 Division of Transplant Surgery, Department of Surgery, Medical University of Vienna, Austria. 4 Division of Nephrology and Gastroenterology, Department of Pediatrics, Medical University of Vienna, Austria. 5 Department of Clinical Pathology, Medical University of Vienna, Austria. 6 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Schiemann
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Puchhammer-Stöckl
authors.forename: Farsad
authors.initials: F
authors.lastname: Eskandary
authors.forename: Philip
authors.initials: P
authors.lastname: Kohlbeck
authors.forename: Susanne
authors.initials: S
authors.lastname: Rasoul-Rockenschaub
authors.forename: Andreas
authors.initials: A
authors.lastname: Heilos
authors.forename: Nicolas
authors.initials: N
authors.lastname: Kozakowski
authors.forename: Irene
authors.initials: I
authors.lastname: Görzer
authors.forename: Željko
authors.initials: Ž
authors.lastname: Kikić
authors.forename: Harald
authors.initials: H
authors.lastname: Herkner
authors.forename: Georg A
authors.initials: GA
authors.lastname: Böhmig
authors.forename: Gregor
authors.initials: G
authors.lastname: Bond
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis / Q000276:immunology* / Q000821:virology; D006801:Humans; D056724:Immunity, Humoral; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D022783:Torque teno virus / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D015415:Biomarkers; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D007518:Isoantibodies