利用Torque Teno病毒作为肾移植受者免疫抑制净状态的串行监测工具。

IF 1.9 4区 医学 Q2 SURGERY
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

摘要

Torque Teno病毒(TTV)已成为反映免疫抑制(IS)净状态和轨迹的有前景的标志物。我们在一项多中心观察性研究中分析了252名肾移植受者的纵向TTV数据(2年内平均7.8次就诊/患者)。患者特定的TTV轨迹,在定义的时间窗口内以斜率计算,捕获了免疫反应动力学的方向。与斜率超过0.0066的患者相比,过去1年logTTV斜率为5.7)的患者发生亚临床AR的几率增加13.88倍(95% CI: 5.49-37.42)。相比之下,过去1年的logTTV斜率bb0 0.076使感染几率比TX增加12.15倍(95% CI: 2.99-81.42)。结合TTV轨迹的决策树对于亚临床AR和感染的auc均为0.67,而使用单一TTV测量的决策树优于tx模型。我们确定了最佳的双侧logTTV阈值-(4.5,7.8)-将患者分层为underis,甚至is和over - is状态,其中underis状态使亚临床AR的几率比TX增加2.39倍(95% CI: 1.53-3.83),而over - is状态使亚临床AR的感染几率增加2.5倍(95% CI: 1.03-6.42)。这些发现为个性化信息系统管理提供了一个框架。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Using Torque Teno Virus as a Serial Monitoring Tool for the Net State of Immunosuppression of Kidney Transplant Recipients

Using Torque Teno Virus as a Serial Monitoring Tool for the Net State of Immunosuppression of Kidney Transplant Recipients

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.

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来源期刊
Clinical Transplantation
Clinical Transplantation 医学-外科
CiteScore
3.70
自引率
4.80%
发文量
286
审稿时长
2 months
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.
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