Kidney Week

Abstract: TH-PO1174

VIRENO Study: A Novel Approach for Early Outcome Prediction after Kidney Transplantation

Session Information

• Late-Breaking Science Posters
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Affeldt, Patrick, Universitatsklinikum Koln, Koln, Nordrhein-Westfalen, Germany

Patrick Affeldt, MD

• Burkert, Katharina, Universitatsklinikum Koln, Koln, Nordrhein-Westfalen, Germany

Katharina Burkert, MD

• Datta, Rabi Raj, Universitatsklinikum Koln, Koln, Nordrhein-Westfalen, Germany

Rabi Raj Datta, MD

• Grundmann, Franziska, Universitatsklinikum Koln, Koln, Nordrhein-Westfalen, Germany

Franziska Grundmann, MD, DrMed

• Kann, Martin, Universitatsklinikum Koln, Koln, Nordrhein-Westfalen, Germany

Martin Kann, MD

• Klein, Florian, Universitatsklinikum Koln, Koln, Nordrhein-Westfalen, Germany

Florian Klein, MD, MSc

• Kurschat, Christine E., Universitatsklinikum Koln, Koln, Nordrhein-Westfalen, Germany

Christine E. Kurschat, MD

• Stippel, Dirk L., Universitatsklinikum Koln, Koln, Nordrhein-Westfalen, Germany

Dirk L. Stippel, DrMed, MBA

• Thomas, Michael Nikolaus, Universitatsklinikum Koln, Koln, Nordrhein-Westfalen, Germany

Michael Nikolaus Thomas

• Tuschen, Katharina, Krankenhaus Koln-Merheim, Koln, Nordrhein-Westfalen, Germany

Katharina Tuschen, DrMed

• Weidemann, Alexander, Krankenhaus Koln-Merheim, Koln, Nordrhein-Westfalen, Germany

Alexander Weidemann, DrMed

• Wilde, Benjamin, Universitat Duisburg-Essen, Duisburg, Nordrhein-Westfalen, Germany

Benjamin Wilde, MD, DrMed

• Di Cristanziano, Veronica, Universitatsklinikum Koln, Koln, Nordrhein-Westfalen, Germany

Veronica Di Cristanziano, DrMed

• Mueller, Roman-Ulrich, Universitatsklinikum Koln, Koln, Nordrhein-Westfalen, Germany

Roman-Ulrich Mueller, MD

Group or Team Name

• The VIRENO Study Group.

Background

Achieving balanced immunosuppression remains a significant challenge following kidney transplantation (KTx). VIRENO is a prospective multicenter study designed to examine the combination of clinical and viro-immunological parameters as predictors of major complications after KTx.

Methods

Viro-immunological monitoring was conducted before KTx, 3 weeks and 6 months after KTx. This monitoring included measurements such as the humoral response to BK polyomavirus (BKPyV) and cytomegalovirus (CMV), T-cell reactivity against CMV, and the viral load of torque teno virus (TTV). Clinical outcomes were tracked for 12 months post-transplantation, with clinically relevant infection- and rejection-related events as outcomeparamter. Clinical and viro-immunological parameters were used to develop predictive models for infectious and immunological events through logistic regression. The best models were then integrated for predicting infections and immunological events to create the VIRENO-score, to stratify patients by adverse event risk after KTx.

Results

A total of 196 patients were followed for the first year post-KTx. Relevant infectious events occurred in 95 patients, while 36 patients experienced at least one immunological event (biopsy-proven rejection / de novo donor-specific antibodies). The best predictive model for significant infections included variables such as baseline plasma TTV-DNA load, CMV serostatus of the donor and recipient, recipient's blood type, type of donation (deceased vs. living), recipient's ethnicity, and differences in HLA alleles between donor and recipient (Area under the curve (AUC) 0.781). For immunological events, the predictive model included nine variables, including baseline CMV-IgG levels, presence of underlying genetic renal diseases, recipient's body mass index, and the number of HLA mismatches and different HLA constellations (AUC 0.799).

Conclusion

The combination of viro-immunological and clinical parameters is a promising tool for predicting major adverse events after KTx. Validation in further cohorts and a prospective trial using the models to guide immunosuppression will now be the crucial steps towards implementation in clinical practice.

Funding

• Other NIH Support