Kidney Week

Abstract: SA-OR85

Impact of Induction Agents on Torque Teno Viral Load and Year-1 Post-transplant Complications in Kidney Transplant Recipients

Session Information

• Transplantation: Clinical Management and Monitoring
  October 26, 2024 | Location: Room 25, Convention Center
  Abstract Time: 05:00 PM - 05:10 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Benning, Louise, Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany

Louise Benning, MD

• Reineke, Marvin, Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany

Marvin Reineke

• Speer, Claudius, Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany

Claudius Speer

• Klein, Julian, Medical Faculty Heidelberg, Department of Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Select a State/Province, Germany

Julian Klein, MD

• Bundschuh, Christian, Medical Faculty Heidelberg, Department of Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Select a State/Province, Germany

Christian Bundschuh, MD, MMSc

• Zeier, Martin G., Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany

Martin G. Zeier, MD, FASN

• Schnitzler, Paul, Medical Faculty Heidelberg, Department of Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Select a State/Province, Germany

Paul Schnitzler, MD

• Morath, Christian, Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany

Christian Morath, MD

Background

Torque teno viral load (TTVL) is gaining importance as a surrogate parameter to assess immunocompetence in kidney transplant recipients and as a potential biomarker for predicting complications post-transplant. Although TTVL kinetics have been examined in several studies, it is unknown to what extent different induction therapies affect TTVL.

Methods

In this retrospective study, TTVL was quantified in 553 plasma or serum samples from 138 patients who underwent kidney transplantation between 2018 and 2021. TTVL was quantified at the time of transplantation and 30, 90, 180, and 360 days thereafter. To evaluate the influence of induction therapy on TTVL, 69 patients receiving anti-thymocyte globulin (ATG) induction were matched with 69 patients receiving an interleukin-2 receptor antagonist (IL2-RA) in terms of age, gender, and donor modality.

Results

Regardless of the type of induction therapy, there was a steep increase in TTVL post-transplant in all patients with peak viral loads at 90 days post-transplant (median TTVL [IQR] 6.62×10⁶, [4.00×10⁵ – 1.04×10⁸]) followed by subsequently declining viral loads. Compared to patients receiving IL2-RA as induction therapy, patients receiving ATG had significantly higher peak viral loads (P=0.0006), as well as significantly higher viral loads one year post-transplant (P=0.012). Among the 69 patients who received ATG induction therapy, 17 patients underwent simultaneous pancreas-kidney transplantation, yet their TTVL did not differ significantly from others receiving ATG as induction therapy. Despite higher TTVL, patients with ATG as induction therapy did not have an increased risk of hospitalization due to infection when compared to patients receiving IL2-RA (HR=0.9363; P=0.6949). Patients whose TTVL 90 days post-transplant exceeded the currently proposed cutoff to prevent infections within the first year post-transplant [6.2 log10] had a higher risk of being hospitalized with an infection in the following 9 months, albeit without being statistically significant (HR=1.569, P=0.0899).

Conclusion

The type of induction agent used markedly affects TTVL post-transplant and should therefore urgently be considered for interpreting and applying TTVL to immunomonitor kidney transplant recipients post-transplant.