#2402 Torque teno virus is associated with an increased risk for malignancies after kidney transplantation

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Abstract Background and Aims The risk for malignancies is increased after kidney transplantation due to immunosuppression. Torque teno virus (TTV) is a ubiquitous and non-pathogenic virus which reflects the immunocompetence of its host. TTV load has been shown to be associated with complications of under- and over-immunosuppression such as graft rejection and infection. No data are available on the association between TTV load and malignancies after kidney transplantation. Method All 604 consecutive recipients of a kidney graft transplanted at Vienna General Hospital between 2016 and 2019 were screened. Main inclusion criteria were a follow-up more than one year post transplant and more than two available TTV measurements in year one post-transplant. TTV was quantified in the plasma using an in-house PCR as described by Maggi and colleagues. Follow-up data were collected for up to five years after transplantation. Results A total of 422 kidney transplant recipients (median age 55 years, 32.5% female) were included in this cohort analysis with a total of 52 incident malignancies occurring more than one year after transplantation (52% skin cancer). Mean TTV from month 4 to 12 post-transplant (TTVmean) was associated with an increased risk for the development of a malignoma (HR 1.38, 95% CI 1.21 to 1.70, p = 0.002). The highest risk for the development of a malignoma was calculated for TTVmean above a cut-off of 7.5 log copies/mL (HR 2.19, 95% CI 1.24 to 3.89, p = 0.007) adjusted for recipient age, sex, history of smoking, and BMI. Conclusion A high Torque teno virus load—suggesting over-immunosuppression—is associated with the development of malignancies in kidney transplant recipients. TTV-guided immunosuppression might provide a useful tool to reduce post-transplant malignancies by avoiding over-immunosuppression.

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