{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T11:12:02Z","timestamp":1787224322284,"version":"build-2736575974"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01 AI084146"],"award-info":[{"award-number":["U01 AI084146"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["3U01 AI063594\u201007S1"],"award-info":[{"award-number":["3U01 AI063594\u201007S1"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["1U01AI088635"],"award-info":[{"award-number":["1U01AI088635"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["2U19 AI063603"],"award-info":[{"award-number":["2U19 AI063603"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R34 AI118493"],"award-info":[{"award-number":["R34 AI118493"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Torque Teno Virus (TTV) has emerged as a promising marker reflecting the net state and trajectory of immunosuppression (IS). We analyzed longitudinal TTV data from 252 kidney transplant recipients in a multi\u2010center observational study (average 7.8 visits\/patient over 2 years). Patient\u2010specific TTV trajectories, computed as slopes over defined time windows, captured the direction of immune response dynamics. A past 1\u2010year logTTV slope\u00a0&lt;\u00a00.0066, combined with a low current logTTV (&lt;4.3) and a relatively high historical logTTV average (&gt;5.7), was associated with a 13.88\u2010fold increase in the odds of subclinical AR (95% CI: 5.49\u201337.42) relative to patients whose slope exceeded 0.0066. In contrast, a past 1\u2010year logTTV slope\u00a0&gt;\u00a00.076 conferred a 12.15\u2010fold rise in the odds of infection over TX (95% CI: 2.99\u201381.42). Decision trees incorporating TTV trajectories achieved AUCs of 0.67 for both subclinical AR and infection versus TX\u2014outperforming models using a single TTV measurement. We identified optimal two\u2010sided logTTV thresholds\u2014(4.5,7.8)\u2014stratifying patients into Under\u2010IS, Even\u2010IS, and Over\u2010IS states, where Under\u2010IS status increases subclinical AR odds over TX by 2.39\u2010fold (95% CI: 1.53\u20133.83), while Over\u2010IS status increases infection odds over subclinical AR by 2.5\u2010fold (95% CI: 1.03\u20136.42). These findings provide a framework for personalized IS management.<\/jats:p>","DOI":"10.1111\/ctr.70321","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T15:36:31Z","timestamp":1758209791000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Using Torque Teno Virus as a Serial Monitoring Tool for the Net State of Immunosuppression of Kidney Transplant Recipients"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9210-8744","authenticated-orcid":false,"given":"Akhil","family":"Singla","sequence":"first","affiliation":[{"name":"Department of Industrial Engineering and Management Sciences McCormick School of Engineering Northwestern University  Evanston Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8893-1545","authenticated-orcid":false,"given":"Kenny","family":"Chen","sequence":"additional","affiliation":[{"name":"Comprehensive Transplant Center Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4394-6763","authenticated-orcid":false,"given":"Blade","family":"Robelly","sequence":"additional","affiliation":[{"name":"Comprehensive Transplant Center Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6106-5531","authenticated-orcid":false,"given":"Christabel","family":"Rebello","sequence":"additional","affiliation":[{"name":"Comprehensive Transplant Center Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3317-6486","authenticated-orcid":false,"given":"Connor","family":"Lantz","sequence":"additional","affiliation":[{"name":"Comprehensive Transplant Center Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6877-9490","authenticated-orcid":false,"given":"Lihui","family":"Zhao","sequence":"additional","affiliation":[{"name":"Comprehensive Transplant Center Feinberg School of Medicine Northwestern University  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohita","family":"Sinha","sequence":"additional","affiliation":[{"name":"Eurofins Transplant Genomics  Lenexa Kansas 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1106-1901","authenticated-orcid":false,"given":"Sanjay","family":"Mehrotra","sequence":"additional","affiliation":[{"name":"Department of Industrial Engineering and Management Sciences McCormick School of Engineering Northwestern University  Evanston Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"issue":"5","key":"e_1_2_10_2_1","first-page":"493","article-title":"End\u2010Stage Renal Disease: Medical Management","volume":"104","author":"Wouk N.","year":"2021","journal-title":"American Family 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