Association of Pre-Transplant Torque Teno Virus Load With Early Post-Transplant Outcomes in Lung Transplant Recipients: A Multicenter Cohort Study

AbstractBackground Torque teno virus (TTV) load has emerged as a potential surrogate marker of net immunosuppression in solid organ transplantation. However, the clinical significance of pre-transplant TTV levels for early outcomes after lung transplantation remains unclear. Methods In this multicenter cohort of 334 adult first-time lung transplant recipients (2015–2022), plasma samples were collected immediately prior to transplantation. The primary endpoint was infection within 3 months. One hundred healthy individuals served as controls for TTV comparisons. Secondary outcomes were acute rejection and 1-year graft failure. Associations were evaluated using multivariable logistic regression for early infection and time-to-event analyses for rejection and graft failure. Results Pre-transplant TTV levels were higher in recipients than in controls (6.7 vs 5.9 log₁₀ copies/mL; pConclusions Pre-transplant plasma TTV load was associated with early infection, fewer rejection events, and increased 1-year graft failure after lung transplantation, supporting its potential role as a biomarker for immune risk stratification.