Torque Teno Virus (TTV), first discovered in 1997, is a non-pathogenic, highly prevalent virus with a notable presence in the human virome. TTV has garnered attention as a potential indicator of immunocompetence in recipients of solid organ transplants. In this review, we discuss the role of TTV as a potential marker for immunosuppression optimization, prediction of graft rejection, and as an indicator of opportunistic infections. We discuss TTV’s behavior over the course of time after transplantation, TTV’s implications in different immunosuppressive regimens, and potential utility in vaccinations. The review synthetizes findings from various studies depicting its potential clinical utility for future personalized patient care.

Left ventricular assist devices are a treatment option for end-stage heart failure patients. Despite advancing technologies, bleeding and thromboembolic events strongly decrease the survival and the quality of life of these patients. Little is known about prognostic factors determining these adverse events in this group of patients. Therefore, we plan to investigate 90 consecutive left ventricular assist device (LVAD) patients and study in vitro fibrin clot properties (clot lysis time, clot permeability, fibrin ultrastructure using a scanning electron microscope) and the calibrated automated thrombogram in addition to the von Willebrand factor antigen, fibrinogen, D-dimer, prothrombin time/international normalized ratio (PT/INR), and activated partial thromboplastin time (APTT) to identify prognostic factors of adverse outcomes during the course of therapy. We plan to assess the hemostasis system at four different time points, i.e., before LVAD implantation, 3–4 months after LVAD implantation, 6–12 months after LVAD implantation, and at the end of the study (at 5 years or at the time of the adverse event). Adverse outcomes were defined as bleeding events (bleeding in general or in the following subtypes: severe bleeding, fatal bleeding, gastrointestinal bleeding, intracranial bleeding), thromboembolic events (stroke or transient ischemic attack, pump thrombosis, including thrombosis within the pump or its inflow or outflow conduits, arterial peripheral thromboembolism), and death.

Four tests assess antibody-mediated rejection (ABMR) in heart transplants: standard of care local endomyocardial biopsy (EMB) histology, EMB molecular analysis (Molecular Microscope® Diagnostic System - MMDx), donor-derived cell-free DNA (dd-cfDNA), and donor-specific antibody (DSA). These tests have become critical for the development and use of novel therapies for ABMR. The Trifecta-Heart study (NCT04707872) aimed to define the relationships among these tests. The study compared standard of care local histology diagnosis to the results of three central tests assessing ABMR: central DSA (One Lambda Inc.), dd-cfDNA (Natera, Inc.), and MMDx rejection assessments in 214 EMBs. Results were primarily expressed as positive-negative to facilitate analysis and to simulate the way all tests are used for clinical decision-making. MMDx diagnosed more ABMR, TCMR, and No rejection (NR) than histology, a pattern confirmed in a validation set from the larger INTERHEART study (NCT02670408). When correlations and partial correlation modeling were used to defined the hierarchy of relationships among all tests, MMDx ABMR correlated more strongly with dd-cfDNA and DSA than did histologic ABMR. In MMDx-histology discrepancies, biopsies with no histologic rejection but with MMDx ABMR had elevated DSA and dd-cfDNA, and biopsies with MMDx NR but histology ABMR had low DSA and dd-cfDNA. DSA-negative ABMR by MMDx or histology had elevated dd-cfDNA, similar to DSA-positive ABMR. Most cases with molecular injury and high dd-cfDNA also had concurrent molecular rejection. These inter-test relationships will be useful in guiding ABMR management, including monitoring of treatment responses and relapses, especially when discrepancies occur.

(1) Background: Advanced heart failure often accompanies ventricular arrhythmias, necessitating antiarrhythmic therapies. Amiodarone, commonly used for this purpose, may induce thyroid dysfunction due to its high iodine content. However, the prevalence and correlation of thyroid dysfunction with amiodarone in end-stage heart failure patients remain unclear. Aim: This study aimed to evaluate the prevalence and types of thyroid dysfunction and their association with amiodarone among 200 patients diagnosed with advanced heart failure eligible for transplantation. (2) Methods: Consecutively enrolled patients received treatment following the European Society of Cardiology guidelines and were followed-up for two years. Ventricular arrhythmias affected 58.5% of the cohort, with 24.5% receiving amiodarone therapy. (3) Results: Thyroid metabolism dysfunction was evident in 61 patients, notably overrepresented in women (p = 0.0028). Hyperthyroidism (34 patients) and hypothyroidism (27 patients) were observed, with a significant amiodarone-related correlation. Despite this, thyroid dysfunction was not associated with increased mortality among the studied group. (4) Conclusions: Thyroid dysfunction is prevalent in advanced heart failure patients, with a notable proportion linked to amiodarone. However, its presence does not correspond to higher mortality rates. Understanding these associations is crucial for effective management in this patient population. Further exploration is warranted to refine approaches to thyroid dysfunction in refractory heart failure.