定量检测 Torque Teno 病毒载量以监测肾移植受者免疫抑制治疗的短期变化。

Quantification of Torque Teno Virus Load to Monitor Short-term Changes in Immunosuppressive Therapy in Kidney Transplant Recipients.

机构信息

Department of Nephrology, Heidelberg University, Heidelberg, Germany.

Department of Infectious Diseases, Virology, Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany.

出版信息

Transplantation. 2023 Dec 1;107(12):e363-e369. doi: 10.1097/TP.0000000000004816. Epub 2023 Oct 6.

DOI:10.1097/TP.0000000000004816

PMID:37798825

Abstract

BACKGROUND

Quantification of torque teno virus (TTV) has been proposed as a surrogate parameter to monitor immunocompetence in kidney transplant recipients (KTRs) early after transplantation. However, its use in monitoring short-term changes of immunosuppression in KTRs late after transplantation requires further investigation.

METHODS

In this post hoc analysis, we quantified TTV load in sera of 76 KTRs, with 43 pausing mycophenolic acid (MPA) 1 wk before to 4 wk after COVID-19 vaccination to increase vaccine response. TTV load was quantified before, 4 wk, and 3 mo postvaccination. Results were compared to 33 KTRs with continued standard immunosuppressive therapy and with 18 hemodialysis as well as 18 healthy control subjects.

RESULTS

TTV load before vaccination was with a median (interquartile range) of 1.39 × 10 4 copies/milliliter (c/mL) (9.17 × 10 1 -2.66 × 10 5 c/mL) highest in KTRs compared to 1.73 × 10 3 c/mL (1.07 × 10 3 -1.31 × 10 4 c/mL) in hemodialysis patients and 1.53 × 10 2 c/mL (6.38-1.29 × 10 3 c/mL) in healthy controls. In KTRs with MPA withdrawal, TTV load decreased significantly from a median (interquartile range) of 1.11 × 10 4 c/mL (4.75 × 10 2 -1.92 × 10 5 c/mL) to 5.24 × 10 3 c/mL (6.92 × 10 2 -6.91 × 10 4 c/mL) 4-5 wk after initiation of MPA withdrawal ( P = 0.003). In patients with MPA withdrawal, TTV load was significantly inversely correlated with COVID-19 or SARS-CoV-2-specific antibodies 4 wk and 3 mo postvaccination ( P = 0.009 and P = 0.004).

CONCLUSIONS

TTV load reflects changes in immunosuppressive therapy even late after transplantation, supporting its use to monitor immunocompetence in KTRs.

摘要

背景

定量检测扭矩腾病毒（TTV）已被提议作为监测肾移植受者（KTR）移植后早期免疫功能的替代参数。然而，在移植后晚期监测 KTR 中免疫抑制作用的短期变化，需要进一步的研究。

方法

在这项事后分析中，我们对 76 名 KTR 血清中的 TTV 载量进行了定量检测，其中 43 名 KTR 在 COVID-19 疫苗接种前 1 周暂停使用霉酚酸（MPA），以增加疫苗反应。在接种疫苗前、4 周和 3 个月后对 TTV 载量进行了定量检测。结果与继续接受标准免疫抑制治疗的 33 名 KTR 以及 18 名血液透析患者和 18 名健康对照者进行了比较。

结果

与血液透析患者（1.73×10 3 c/mL，1.07×10 3 -1.31×10 4 c/mL）和健康对照组（1.53×10 2 c/mL，6.38-1.29×10 3 c/mL）相比，接种疫苗前 TTV 载量最高（中位数（四分位数范围）），KTR 为 1.39×10 4 c/mL（9.17×10 1 -2.66×10 5 c/mL）。在 MPA 停药的 KTR 中，TTV 载量从中位数（四分位数范围）1.11×10 4 c/mL（4.75×10 2 -1.92×10 5 c/mL）显著下降至 MPA 停药后 4-5 周的 5.24×10 3 c/mL（6.92×10 2 -6.91×10 4 c/mL）（P=0.003）。在 MPA 停药的患者中，TTV 载量与 COVID-19 或 SARS-CoV-2 特异性抗体在接种疫苗后 4 周和 3 个月时呈显著负相关（P=0.009 和 P=0.004）。