Schiemann Martin, Puchhammer-Stöckl Elisabeth, Eskandary Farsad, Kohlbeck Philip, Rasoul-Rockenschaub Susanne, Heilos Andreas, Kozakowski Nicolas, Görzer Irene, Kikić Željko, Herkner Harald, Böhmig Georg A, Bond Gregor
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.
Transplantation. 2017 Feb;101(2):360-367. doi: 10.1097/TP.0000000000001455.
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.
抗体介导的排斥反应（AMR）是肾移植后晚期移植肾丢失的主要原因之一，因此迫切需要非侵入性工具来改善这种排斥反应类型的早期诊断。一种有前景的策略可能是对高度普遍且无致病性的细小病毒B19（TTV）的外周血DNA水平进行定量，这可能反映免疫抑制的总体水平，从而有助于确定同种免疫反应的风险。
为了评估外周血中TTV载量与AMR之间的关联，对715名肾移植受者（移植后中位数为6.3年）进行了系统性横断面AMR筛查，并同时进行TTV定量分析。
这些受者中有86人具有供体特异性抗体并接受了方案活检，AMR阳性患者（n = 46）的TTV水平仅为无AMR患者的25%（P = 0.003）。在广义线性模型中，在调整潜在混杂因素后，较高的TTV水平与AMR风险降低相关（每TTV对数水平的风险比为0.94；95%置信区间为0.90 - 0.99；P = 0.02）。
未来的研究将必须阐明TTV载量的纵向评估是否可以预测AMR风险，并有助于指导免疫抑制的类型和强度，以预防抗体介导的移植物损伤。
