The BK virus is a virus that most people get in childhood. Symptoms can feel like a common cold. Once you get a BK virus infection, the virus stays in your system for good but in an inactive state.
When you take anti-rejection medications due to an organ transplant, the BK Virus can become active to the point that it will damage kidneys.
After getting a liver and kidney transplant, most of my prior bloodwork continued. These tested creatinine, organ enzymes, and other aspects that showed how happy my body and the new organs were.
New bloodwork was added to verify how much immunosuppression drugs were in my system. Without sufficient suppression, my body would reject the new organs as alien (not-my-dna) invaders. With too much suppression, it would increase my chance of infections, damage the new organs (e.g. nephrotoxicity), and cause other unpleasant symptoms.
Further new bloodwork was added to check for active infections that immune suppression could make more likely.
The whole system is complicated by the patient-specific efficacy of the drugs. So the doctors use try, discern, adjust, and repeat…
One of the main goals of the frequent blood work was to tailor the amount of immunosuppressant I needed to be dosed with. After discharge I was on Tacrolimus (Prograph) and Mycophenolate Mofetil (CellCept) to prevent rejection of the new liver and kidney. There is no goal for how much of an immunosuppressant a patient consumes, there is a goal for how much of the immunosuppressant is present in the patient's blood stream. Different patients process the drugs differently, so the bloodwork measures the results. Fiddling with the dosage will change how much of the drug is in the bloodstream.
For consistency and accuracy of the bloodstream value, bloodwork should be done about twelve hours after the last dosing of the every-twelve-hour immunosuppressant. This is called the ‹Trough› value. Since bloodwork is done in the mornings, you delay the morning dosing until after the bloodwork. Based on this trough value, the dosage may be increased or decreased later in the day.
The pattern of my Prograph dosage (in milligrams) and Tacrolimus levels (in nanograms per milliliter of blood) looked like the following in the first few months. Ultimately it reached a stable amount of a dosage of 2.5mg and a trough level of about 7 ng/ml. This lasted for several months after before being adjusted again.
The pattern of my CellCept dosage was quite different and based on a different issue. It was never tailored based on my body's efficacy toward the drug, but instead was based on my body's reaction to an infection. Ignoring the infection, the graph looks like the doctors randomly wanted to have the Mycophenalate go to zero for a while before returning to 1ug/mL
A few weeks after the transplant, I had no evidence of the BK Virus. Two weeks later, it was present. And two weeks after that it was signifcant. This is what drove halfing and ultimately pausing the CellCept dosage. Eventually the level of BK Virus was relatively stable and at an acceptable level, and I was returned to the half-dosage.
At the same time my Tacrolimus levels were getting in better control too, as the initial graph showed.
During the summer and autumn after transplant I seemed to get a number of colds (which was unusual for me) and they lasted for much longer than they normally last for me. This may be a side effect of the suppression or just coincidence.
