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Quantification of torque teno virus and Epstein-Barr virus is of limited value for predicting the net state of immunosuppression after lung transplantation

Journal article
Authors Rickard Nordén
Jesper Magnusson
Anna Lundin
Ka-Wei Tang
Staffan Nilsson
Magnus Lindh
Lars-Magnus Andersson
Gerdt C. Riise
Johan Westin
Published in Open Forum Infectious Diseases
Volume 5
Issue 4
Publication year 2018
Published at Department of Mathematical Sciences
Institute of Biomedicine, Department of Medical and Clinical Genetics
Institute of Medicine, Department of Internal Medicine and Clinical Nutrition
Institute of Biomedicine, Department of Infectious Medicine
Language en
Keywords Biomarker, Epstein-Barr virus, Immunosuppression, Infection, Lung-transplantation, Rejection, Torque teno virus
Subject categories Infectious Medicine


© The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. Background. Major hurdles for survival after lung transplantation are rejections and infectious complications. Adequate methods for monitoring immune suppression status are lacking. Here, we evaluated quantification of torque teno virus (TTV) and Epstein-Barr virus (EBV) as biomarkers for defining the net state of immunosuppression in lung-transplanted patients. Methods. This prospective single-center study included 98 patients followed for 2 years after transplantation. Bacterial infections, fungal infections, viral respiratory infections (VRTI), cytomegalovirus (CMV) viremia, and acute rejections, as well as TTV and EBV levels, were monitored. Results. The levels of torque teno virus DNA increased rapidly after transplantation, likely due to immunosuppressive treatment. A modest increase in levels of Epstein-Barr virus DNA was also observed after transplantation. There were no associations between either TTV or EBV and infectious events or acute rejection, respectively, during follow-up. When Tacrolimus was the main immunosuppressive treatment, TTV DNA levels were significantly elevated 6-24 months after transplantation as compared with Cyclosporine treatment. Conclusions. Although replication of TTV, but not EBV, appears to reflect the functionality of the immune system, depending on the type of immunosuppressive treatment, quantification of TTV or EBV as biomarkers has limited potential for defining the net state of immune suppression.

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