Based on recent FDA warnings about the link between immunosuppressant drugs and BK virus infection in transplanted kidneys, it seems prudent to conduct research into the mechanistic causes of BK-induced nephropathy in transplant patients so that appropriate and standardized prevention and treatment measures, and potentially a cure, can be developed.
Does BK infection originate from the allograft, the environment, or both? What tests can be developed to better detect BK in a donor kidney? Are there any lifestyle changes that the transplant recipient can make to reduce the chances of BK infection? What is the likelihood that a patient who has lost an allograft to BK will contract the virus in a second transplant?
There is evidence that the initially prescribed dose of mycophenolate mofetil is too high in some patients and that it acts as a gateway to BK. Blood tests for MMF levels are contraindicated because they are so expensive. Why are tacrolimus levels followed very closely after transplant while MMF levels are not? The FDA has issued warnings about the link between both these drugs and BK.
Many transplant centers do not routinely analyze the blood/urine of transplant patients for BK, so it is often not detected until significant damage has been done. Are routine analyses needed? How can biopsies of the allograft be prescribed and analyzed to better detect BK early?
Currently, there is conflicting information regarding treatment -- do high doses of steroid help or hinder? Which immunosuppressants should be reduced (and by exactly how much) or stopped altogether? Can an antiviral medication be developed to cure BK infection?
