HIGH Torque Teno virus (TTV) levels were associated with an increased risk of malignancy following kidney transplantation, highlighting the potential of viral load monitoring to support more personalised immunosuppressive treatment. Findings from a prospective observational study suggested that TTV could offer an additional indicator of cancer risk in kidney transplant recipients.
Malignancy is a recognised complication following kidney transplantation, largely associated with the effects of immunosuppressive therapy. TTV, a widespread and non-pathogenic virus, has emerged as a potential marker of immune status, with previous research linking viral load to both insufficient and excessive immunosuppression.
However, its relationship with post-transplant malignancy had remained unclear.
The single-centre study evaluated 428 patients who underwent kidney transplantation at the General Hospital of Vienna, Austria, between 2016 and 2019. Researchers measured plasma TTV levels using quantitative PCR and investigated the incidence of first malignancy between Years 2 and 5 following transplantation.
During the study, 53 patients developed malignancy, with cutaneous keratinocyte cancer accounting for 53% of cases.
Mean TTV levels between Months 4 and 12 after transplantation were associated with increased malignancy risk. The unadjusted hazard ratio (HR) was 1.25 (95% confidence interval [CI]: 1.02–1.54). Following adjustment for age, sex, smoking, and body mass index, the association was attenuated (HR: 1.20; 95% CI: 0.97–1.48).
In a subgroup analysis, the association remained significant following additional adjustment for tacrolimus and mycophenolate exposure (HR: 1.31; 95% CI: 1.03–1.67).
Notably, patients with mean TTV levels above eight, using a previously proposed threshold associated with infection risk, had a substantially higher risk of malignancy (HR: 2.10; 95% CI: 1.22–3.60).
The findings suggest that elevated TTV levels could identify kidney transplant recipients at increased risk of subsequent malignancy, potentially reflecting more intensive immunosuppression.
Monitoring TTV may therefore offer an additional approach to assessing immune status and informing individualised immunosuppressive treatment. This could help clinicians balance the need to prevent graft rejection against the risks associated with excessive immunosuppression.
Although the observational findings establish an association rather than causation, they highlight a potential role for TTV monitoring in post-transplant risk assessment. Further investigation will be important to establish whether incorporating TTV measurements into clinical management can help reduce malignancy risk while maintaining graft outcomes.
Reference
Herz CT et al. Torque Teno virus is predictive for malignancies after kidney transplantation. Nephrol Dial Transplant. 2026;41(11):2053-61.
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