优化个体免疫抑制可以降低移植物丢失和患者死亡的风险，被认为是改善肾移植长期结果的最佳方法。扭矩特诺病毒 (TTV) DNA 血症已成为反映移植后第一年治疗性免疫抑制深度的潜在生物标志物。然而，其长期监测的效果仍不确定。在一项涉及 34 名稳定肾移植受者和 124 名健康志愿者的队列研究中，我们确定了 TTV DNAemia 阈值的下限和上限 (3.75-5.1 log10 cp/mL)，与 T 细胞激活性、针对流感疫苗的抗体反应以及随后发生严重流感的风险相关。超过 50 个月的感染或癌症。在一个由 92 名受者组成的独立队列中进行的验证证实，在 > 50% 的随访时间点内将 TTV DNAemia 维持在该范围内与因免疫抑制不足而降低并发症的风险相关，包括从头 DSA、活检证明的抗体介导的排斥反应、移植物丢失、感染或癌症。多变量分析强调，“目标内”TTV DNAemia 是唯一的自变量，与免疫抑制不足导致长期并发症风险降低显着相关（比值比 [OR]：0.27 [0.09-0.77]；p = 0.019）。我们的数据表明，对肾移植受者 TTV DNAemia 进行纵向监测有助于预防因免疫抑制不足而导致的长期并发症。© 2024 Wiley periodicals LLC。

Optimization of individual immunosuppression, which reduces the risks of both graft loss and patients' death, is considered the best approach to improve long-term outcomes of renal transplantation. Torque Teno Virus (TTV) DNAemia has emerged as a potential biomarker reflecting the depth of therapeutic immunosuppression during the initial year post-transplantation. However, its efficacy in long-term monitoring remains uncertain. In a cohort study involving 34 stable kidney transplant recipients and 124 healthy volunteers, we established lower and upper TTV DNAemia thresholds (3.75-5.1 log10 cp/mL) correlating with T-cell activatability, antibody response against flu vaccine, and risk for subsequent serious infections or cancer over 50 months. Validation in an independent cohort of 92 recipients confirmed that maintaining TTV DNAemia within this range in >50% of follow-up time points was associated with reduced risks of complications due to inadequate immunosuppression, including de novo DSA, biopsy-proven antibody-mediated rejection, graft loss, infections, or cancer. Multivariate analysis highlighted "in-target" TTV DNAemia as the sole independent variable significantly linked to decreased risk for long-term complications due to inadequate immunosuppression (odds ratio [OR]: 0.27 [0.09-0.77]; p = 0.019). Our data suggest that the longitudinal monitoring of TTV DNAemia in kidney transplant recipients could help preventing the long-term complications due to inadequate immunosuppression.© 2024 Wiley Periodicals LLC.