What does this research mean for the field?

Higher pre-transplant Torque Teno Virus (TTV) load in lung transplant recipients is associated with an increased risk of early infection and 1-year graft failure, but a decreased risk of acute rejection. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to determine the association of pre-transplant TTV load with early outcomes post-lung transplantation.

March 24, 2026The Journal of Heart and Lung TransplantationOpen Access

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

Q: What are the key findings of this study?

Each 1-log10 increase in pre-transplant TTV load in lung recipients increased early infection risk (aOR 15.05) and 1-year graft failure (aHR 1.40), but reduced acute rejection (aHR 0.70).

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Key result

Higher pre-transplant TTV load is linked to ~30% less acute rejection but more infections and graft failure.

aOR 15.05
aHR 1.40
aHR 0.70

Why the study?

Torque teno virus load is a potential surrogate marker of net immunosuppression, but the clinical significance of pre-transplant levels for early outcomes after lung transplantation remains unclear.

Does pre-transplant Torque teno virus (TTV) load predict early post-transplant infection, acute rejection, and 1-year graft failure in lung transplant recipients?

Comparison

Pre-transplant Torque teno virus levels

Design

Multicenter cohort study

Follow-up

Up to 1 year

Authors

HLHyunJi LeePusan National University Yangsan Hospital WCWoo Hyun ChoMemorial Sloan Kettering Cancer Center KKKipoong KimChangwon National University

Discussion

Member takes

Implication

Supports pre-transplant TTV for immune risk stratification in lung recipients; hypothesis-generating and requires prospective validation before adoption.

Key Points

The study aims to determine the association of pre-transplant TTV load with early outcomes post-lung transplantation.
Conducted a multicenter cohort study involving 334 first-time lung transplant recipients.
Plasma samples were collected before transplantation to measure TTV levels.
Primary endpoint assessed was infection within 3 months post-transplant.
Used multivariable logistic regression and time-to-event analyses to evaluate outcomes.
Pre-transplant TTV levels were significantly higher in transplant recipients compared to controls.
30.8% of recipients developed early infections; those with infections had higher TTV levels.
Each 1-log₁₀ increase in TTV correlated with a significantly higher infection risk.
Higher TTV levels were linked to lower acute rejection risks and increased 1-year graft failure rates.

Structured PICO

Does pre-transplant Torque teno virus (TTV) load predict early post-transplant infection, acute rejection, and 1-year graft failure in lung transplant recipients?

Population

334 adult first-time lung transplant recipients (2015–2022) from 6 major centers in Korea, excluding those with missing plasma, hemolysis, or re-transplantation. 100 healthy individuals served as controls.

Intervention

Pre-transplant plasma Torque teno virus (TTV) load measurement

Comparator

Lower pre-transplant TTV levels (<7.38 log10 copies/mL) or healthy controls

Outcome

Infection within 3 months post-transplantationhard clinical

Higher pre-transplant plasma TTV load is a strong predictor of early post-transplant infection and 1-year graft failure, but is associated with fewer acute rejection events, highlighting its potential as a biomarker for immune risk stratification.

Limitations

Conducted exclusively among Korean lung transplant recipients, limiting generalizability
Viral and fungal infections were uncommon, limiting pathogen-specific analyses
Retrospective observational design limits causal inference
Lack of international assay standardization for TTV quantification

Cite This Study

Lee et al. (2026) studied this question. Each 1-log10 increase in pre-transplant TTV load in lung recipients increased early infection risk (aOR 15.05) and 1-year graft failure (aHR 1.40), but reduced acute rejection (aHR 0.70).

synapsesocial.com/papers/69c2294caeb5a845df0d3980 https://doi.org/10.1016/j.healun.2026.03.017

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Implication

Supports pre-transplant TTV for immune risk stratification in lung recipients; hypothesis-generating and requires prospective validation before adoption.

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

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

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

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider