Akhil Singla, Kenny Chen, Blade Robelly, Christabel Rebello, Connor Lantz, Lihui Zhao, Rohita Sinha, Sook Park, Steve Kleiboeker, John J. Friedewald, Sanjay Mehrotra
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引用次数: 0
Abstract
Torque Teno Virus (TTV) has emerged as a promising marker reflecting the net state and trajectory of immunosuppression (IS). We analyzed longitudinal TTV data from 252 kidney transplant recipients in a multi-center observational study (average 7.8 visits/patient over 2 years). Patient-specific TTV trajectories, computed as slopes over defined time windows, captured the direction of immune response dynamics. A past 1-year logTTV slope < 0.0066, combined with a low current logTTV (<4.3) and a relatively high historical logTTV average (>5.7), was associated with a 13.88-fold increase in the odds of subclinical AR (95% CI: 5.49–37.42) relative to patients whose slope exceeded 0.0066. In contrast, a past 1-year logTTV slope > 0.076 conferred a 12.15-fold rise in the odds of infection over TX (95% CI: 2.99–81.42). Decision trees incorporating TTV trajectories achieved AUCs of 0.67 for both subclinical AR and infection versus TX—outperforming models using a single TTV measurement. We identified optimal two-sided logTTV thresholds—(4.5,7.8)—stratifying patients into Under-IS, Even-IS, and Over-IS states, where Under-IS status increases subclinical AR odds over TX by 2.39-fold (95% CI: 1.53–3.83), while Over-IS status increases infection odds over subclinical AR by 2.5-fold (95% CI: 1.03–6.42). These findings provide a framework for personalized IS management.
期刊介绍:
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.