TOPLINE:

Among adult kidney transplant recipients, higher plasma loads of torque teno virus (TTV) during months 4-12 post-transplant were associated with an increased risk for malignancies in the following 4 years.

METHODOLOGY:

• Researchers conducted a secondary analysis of a prospective clinical trial to assess the association between TTV load, as a marker of immunosuppressive burden, and the risk for malignancies after kidney transplant.
• They included 428 adult kidney transplant recipients (median age, 55 years; 32.2% women) with at least one TTV load measurement between days 90 and 365 post-transplant, a peak TTV load of ≥ 10⁶ copies per mL during the first year, and an in-centre follow-up duration of more than 1 year.
• The primary endpoint was the time from day 365 after kidney transplant to the diagnosis of the first malignancy or death due to malignancy, assessed during years 2-5 post-transplant, with a maximum follow-up duration of 5 years.
• TTV load in plasma was measured before transplant, weekly during the hospitalisation after transplant, at the first outpatient visit, and then every 3 months during the first year post-transplant.
• A subgroup analysis was performed among patients (n = 397) receiving tacrolimus- and mycophenolate mofetil-based immunosuppression to determine whether the relationship between TTV load and subsequent risk for malignancy was independent of exposure to these common immunosuppressive agents.

TAKEAWAY:

• During years 2-5 after kidney transplant, 53 kidney transplant recipients developed malignancy as a primary event; 53% of these malignancies were cutaneous keratinocyte cancers.
• Patients with a mean log₁₀ TTV load of > 8 copies per mL during months 4-12 had more than double the risk for malignancy than those with a load of £ 8 copies per mL (hazard ratio [HR], 2.10; P = .007).
• Mean log₁₀ TTV load during months 4-12 post-transplant was associated with an increased risk for malignancy (HR, 1.25; P = .03) in an unadjusted analysis.
• Among patients who received tacrolimus- or mycophenolate mofetil-based immunosuppression, higher TTV load during months 4-12 post-transplant was independently associated with an increased risk for malignancy (adjusted HR, 1.31; P = .028).

IN PRACTICE:

"Our findings suggest that monitoring the TTV load during the first year post-transplant may help identify patients at increased risk of subsequent malignancies. This could potentially inform individualized surveillance strategies and guide immunosuppression management," the authors wrote.

SOURCE:

This study was led by Carsten T. Herz, Medical University of Vienna, Vienna, Austria. It was published online on April 06, 2026, in Nephrology Dialysis Transplantation.

LIMITATIONS:

This single-centre study was conducted in a predominantly White, central European population, which may have limited generalisability. Complete follow-up data were not available for all patients as some patients continued care at other hospitals. Additionally, the researchers did not collect or analyse follow-up data beyond 5 years.

DISCLOSURES:

The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.