In Reply Our trial to test a strategy to prevent BK infection was motivated by limitations of the current reactionary approach to management that involves reduction in immunosuppression after development of infection. However, because the alternative surrogate outcome of immunosuppression reduction suggested by Dr Landman was not evaluated in our trial, we cannot offer a formal opinion regarding its potential use. In our opinion, because the decision to reduce immunosuppression may be influenced by many other factors, including risk of rejection, this outcome may be difficult to implement in a clinical trial.
Gill JS, Knoll GA, Humar A. BK Virus Prophylaxis With Levofloxacin—Reply. JAMA. 2015;313(11):1165-1166. doi:10.1001/jama.2015.1058