To the Editor Dr Knoll and colleagues1 performed a randomized clinical trial of BK virus prophylaxis with levofloxacin after kidney transplantation. The authors did not find a reduction in BK viruria, the primary outcome, with approximately 30% of patients developing low-level viruria and 10% viremia.
The current strategy to prevent BK nephropathy is screening for BK viruria followed by intensive monitoring and reductions in immunosuppressive medication when viruria progresses or viremia develops. Although the authors primarily aimed to lower viruria, I am interested in their opinion on whether the difference in percentages of patients who do not need a dose reduction of immunosuppressive medication could also be an appropriate surrogate end point for future studies.
Landman GWD. BK Virus Prophylaxis With Levofloxacin. JAMA. 2015;313(11):1165. doi:10.1001/jama.2015.1052