System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Ahead of print

PubMed: 42420873 DOI: 10.1186/s12882-026-05192-6

Association between Torque teno virus-DNA plasma loads and post-transplantation diabetes mellitus in the first year after kidney transplantation.

BMC Nephrol

Authors: Felix Eisinger, Charikleia Gkioule, Anja Schork, Silvio Nadalin, Andreas Birkenfeld, Thomas Iftner, Nils Heyne, Martina Guthoff, Tina Ganzenmueller

Affiliations

  • Internal Medicine IV, Department of Diabetology, Endocrinology and Nephrology, University of Tübingen, Tübingen, Germany.
  • Institute for Diabetes Research and Metabolic Diseases (IDM) of Helmholtz Munich, University of Tübingen, Tübingen, Germany.
  • German Center for Diabetes Research (DZD), Tübingen, Germany.
  • Institute of Medical Virology, University Hospital Tübingen, Elfriede-Aulhorn-Str. 6, 72076, Tübingen, Germany. German Center for Infection Research (DZIF) at the University Hospital Tübingen, Tübingen, Germany.
  • Department of General and Transplant Surgery, University of Tübingen, Tübingen, Germany.
  • Institute of Medical Virology, University Hospital Tübingen, Elfriede-Aulhorn-Str. 6, 72076, Tübingen, Germany.
  • German Center for Infection Research (DZIF) at the University Hospital Tübingen, Tübingen, Germany.
  • Nephrological Center Villingen-Schwenningen, Villingen-Schwenningen, Germany.
  • Institute of Medical Virology, University Hospital Tübingen, Elfriede-Aulhorn-Str. 6, 72076, Tübingen, Germany.
  • German Center for Infection Research (DZIF) at the University Hospital Tübingen, Tübingen, Germany.

Abstract

BACKGROUND

Torque teno virus (TTV) DNAemia is a surrogate marker of immune function in renal transplant recipients (RTRs), usually peaking around 3 months after transplantation. Post-transplantation diabetes mellitus (PTDM), a condition with impaired immune response, is common after renal transplantation, but its relationship with TTV replication remains unclear.

METHODS

In this retrospective study, TTV-DNA loads were analysed in 303 plasma samples from 93 RTRs collected shortly after transplantation and at 3, 6, and 12 months. Clinical and laboratory parameters, including glycaemic status, were assessed. 17 patients (18.3%) developed PTDM.

RESULTS

As expected, TTV-DNA plasma loads peaked at 3 and 6 months in the cohort. Upon multivariate analysis, time after transplantation (p < 0.001), tacrolimus trough levels, (p = 0.001), and HbA1c (p = 0.012) were associated with TTV-DNA plasma loads. Patients with PTDM, but not with pre-existing diabetes mellitus, showed significantly higher TTV-DNAemia at 3 months (p = 0.03) and 6 months (p = 0.01) after transplantation compared to non-diabetic patients. No significant group differences were observed for cumulative prednisolone dose, tacrolimus trough levels and induction therapy. Although patients with PTDM were older, age contributed only marginally to TTV-DNAemia. Opportunistic viral infections tended to occur more frequently in patients with PTDM.

CONCLUSIONS

In conclusion, PTDM but not pre-existing diabetes was associated with elevated TTV-DNA plasma loads early after transplantation in this retrospective cohort analysis. Patients with PTDM also showed a trend towards more opportunistic infections, although this observation should be interpreted cautiously given the small number of events. These findings suggest a potential association between PTDM and altered immune regulation in RTRs that warrants further investigation.

MeSH

Torque Teno Virus, Diabetes Mellitus, Kidney Diseases, Kidney, Tacrolimus, Viruses, Transplants, Kidney Transplantation, Dna, Transplantation, Infections, Dna Viruses, Plasma