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One promising strategy relies on the monitoring of replication kinetics of virome components as functional surrogate for the net state of immunosuppression. Torque Teno Virus (TTV) is a small, non\u2010enveloped, circular, single\u2010stranded DNA anellovirus with no attributable pathological effects. A major component of the human blood virome, TTV exhibits various features that facilitate its application as immune biomarker: high prevalence rates, nearly ubiquitous distribution, stable viral loads with little intra\u2010individual variability, insensitivity to antiviral drugs, and availability of commercial PCR assays for DNA quantification. The present review summarizes the available studies supporting the use of post\u2010transplant TTV viremia to predict patient and graft outcomes after SOT and allo\u2010HSCT. Taken together, this evidence suggests that high or increasing TTV DNA levels precede the occurrence of infectious complications in the SOT setting, whereas low or decreasing viral loads are associated with the development of acute rejection. The interpretation in allo\u2010HSCT recipients is further complicated by complex interplay with the underlying disease, conditioning regimen, and timing of recovery of lymphocyte counts, although TTV kinetics may act as a marker of immunological reconstitution at the early post\u2010transplant period. The standardization of PCR methods and reporting units for TTV DNAemia and the results from ongoing interventional trials evaluating a TTV load\u2010guided strategy to adjust immunosuppressive therapy are achievements expected in the coming years.<\/jats:p>","DOI":"10.1111\/tid.13778","type":"journal-article","created":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T16:33:45Z","timestamp":1640104425000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":77,"title":["Viruses, friends, and foes: The case of Torque Teno Virus and the net state of immunosuppression"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9356-8102","authenticated-orcid":false,"given":"Natalia","family":"Redondo","sequence":"first","affiliation":[{"name":"Unit of Infectious Diseases, Hospital Universitario \u201c12 de Octubre\u201d Instituto de Investigaci\u00f3n Sanitaria Hospital \u201c12 de Octubre\u201d (imas12)  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