TABLE 9.

Consensus recommendations: PK and PD aspects

• We recommend interpreting dosing and trough concentrations of immunosuppressive drugs in the context of PK/PD, drug–drug interactions (including all other medications, any alternative and complimentary medicines, and over-the-counter medications), as well as liver and kidney function when managing patients with BKPyV-DNAemia/-nephropathy (strong, B)

• We suggest carefully considering and monitoring the interactive PK/PD role(s) of immunosuppression on promoting or inhibiting viral replication, kinetics, and dynamics of BKPyV-DNAemia (weak, C)

• We recommend providing ongoing medication education to patients and caregivers regarding medication adherence and routinely assessing adherence (strong, B)

Future directions

➢ Evaluate the role of immunosuppressive drugs in different compartments, such as unbound (free), total, or intracellular concentration, to guide the management of BKPyV-DNAemia/-nephropathy

➢ Evaluate the PK/PD of immunosuppressive drugs for optimizing prevention and treatment of BKPyV-DNAemia/-nephropathy in pediatric and adult kidney transplant recipients

➢ Include PK/PD analyses of novel agents in both pediatric and adult transplant populations, focusing on the prevention/treatment of BKPyV-DNAemia/-nephropathy

BKPyV, BK polyomavirus; PD, pharmacodynamics; PK, pharmacokinetics.