#2342 Long term monitoring of torque teno virus load for the detection of infections in kidney transplantation

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Abstract Background and Aims Personalized balance of immunosuppression is crucial to prevent organ rejection and infections in kidney transplant recipients. Plasma load of the non-pathogenic and highly prevalent torque teno virus (TTV) has been suggested to assess the state of immunosuppression. A cut-off value for risk prediction of infections in the first year post-transplant has been defined and is currently tested in an interventional randomized clinical trial (TTVguideIT). Defining cut-off values beyond year one post-transplant are crucial for the design of follow-up trials (e.g. TAOIST) and long term routine clinical care. Method For this secondary analysis of the prospective single-center AdTorque study, all 268 consecutive adult patients who underwent a kidney transplantation between January 1st, 2018 and December 31st, 2019 at the Medical University of Vienna were included and followed up for a maximum of 4 years. Over this time, all infectious events with respective treatments, hospitalizations and changes of immunosuppression were recorded. Infectious disease work up included syndromic PCR panel testing, among others including SARS-CoV-2 PCR. Additionally, immunologic monitoring via TTV PCR from plasma was performed. Results In a preliminary analysis including 150 patients (37.2% female; median age 52.7 years) 621 infectious events were recorded, with 24 patients not experiencing an infection. Of all events the majority were urinary tract infections (n = 204; 32.9%), 178 of all events led to hospitalization. The most commonly identified pathogens were cytomegalovirus (n = 97), Escherichia coli (n = 71) and SARS-CoV-2 (n = 53). The overall event rate declined over the first three years post-transplant, with a rise in the fourth year (year 1: 94.9%; year 2: 48.0%; year 3: 44.7%; year 4: 78.4%). Conclusion This interim analysis gives valuable insight on the epidemiology of infectious disease in the current post-transplant era. The strength of the study is the long term follow-up, the overlap with the height of the COVID-19 pandemic and the inclusion of multiplex PCR panels in routine work-up. The full data set including associations with TTV load and respective cutoffs are currently being assessed, and will be presented at ERA 2025 in case of acceptance.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.