Torquetenovirus Serum Load and Long-Term Outcomes in Renal Transplant Recipients

Figures

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  Figure 1. Kaplan–Meier plots showing differences in survival (A,B), and graft failure (C) over time between undetectable low torquetenovirus TTV (black), low TTV (light blue), medium TTV (red) and high TTV (orange), as measured in a serum sample tested at least 12 months after transplantation. Time from testing is displayed (A) All-cause mortality (p < 0.001, (B) Death due to infectious causes (p = 0.08), (C)) graft survival (p = 0.51).

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  Figure 2. Hazard ratios calculated using Cox models and presented as a forest plot. (A) Log10 TTV is predictive of all-cause mortality after adjustment for age, gender, eGFR proteinuria, time since transplant and the number of immunosuppressant’s used. This means that for each log increase in TTV, there is a 12% increase for a patient’s risk of death (HR 1.12 (95% CI 1.0.2–1.23), p = 0.02). (B) Log10 TTV is predictive of death due to an infectious cause after adjustment for age, gender, eGFR proteinuria, time since transplant and the number of immunosuppressant’s used. This means that for each log increase in TTV, there is a 20% increase for a patient’s risk of death (HR 1.20 (95% CI 1.01–1.43), p = 0.04). (C) Log10 TTV is not predictive of graft failure after adjustment for age, gender, eGFR, proteinuria, time since transplant and the number of immunosuppressant’s used. a Categorical variable used for death due to an infectious cause. b Categorical variable used for all-cause mortality and graft failure.

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  Figure 3. Scatter plot showing levels of TTV in our transplant patients and their outcomes in all-cause mortality (A), and death due to infectious causes (B). TTV levels are higher in the first years after transplantation than in later years. Patients with worse outcome show a trend of higher TTV levels over the entire follow-up period.

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  Figure 4. Forest plots with hazard table of Cox models after adjustment for age, gender, eGFR proteinuria, and the number of immunosuppressant’s used. (A) All-cause mortality in patients transplanted within 24 months of TTV analysis; this includes 31 events. Log10 TTV cannot be used to predict risk of death transplanted within 24 months of TTV analysis. (B) All-cause mortality in patients tested over 24 months after transplantation, this includes 110 events. Log10 TTV is highly predictive of the risk of death for patients with elevated TTV (HR 1.19 (95%CI 1.06–1.33), p < 0.01). (C) Log10 TTV is not predictive of death due to an infectious cause in patients tested over 24 months since transplantation (HR 1.15 (95% CI 0.82–2.25), p = 0.86). (D) Log10 TTV is predictive of death due to an infectious cause in patients 24 months after transplantation (HR 1.24 (95%CI 1.01–1.52), p = 0.04). a Categorical variable used for death due to an infectious cause. b Categorical variable used for all-cause mortality.