In 1954, Dr. Joseph E. Murray of Brigham and Women’s Hospital in Boston completed the first successful organ transplant: a renal transplant between twin brothers. Since then, there has been a string of successful firsts in organ transplants. Though experts and their patients have enjoyed a great deal of success with transplants of ever-increasing complexity, the process by which organ transplants occur still harbors many flaws.
Early procedures were faced with complications that, in this day and age, are more feasibly overcome. Issues such as non-matching blood types between donors and recipients, a lack of suitable organ donors — which lead to the use of animal donors —and a generally low level of physician experience ruined early attempts. Today, doctors are faced with subtler challenges that include managing immunosuppressant dosages — drugs that inhibit the immune system — and the onset of latent viral infections.
But Dr. Madhu Bhaskaran, principal investigator at the Kidney Transplant Center at Northwell Health on Long Island, aims to improve long-term kidney transplant viability.
Bhaskaran’s work currently focuses on the transmission and infectivity of BK virus, a rather docile virus with low pathogenicity and few symptoms in healthy humans. It is estimated that around 80% of the population has BK virus (BKV), which lies dormant until the host body experiences some sort of suppression of the immune system. In such cases, the previously harmless virus can cause renal dysfunction and other problems related to the kidney. Since immunosuppressants are needed for recipients to effectively accept donor organs, doctors can often find themselves at a crossroads between immunosuppression and viral infection.
BKV infections are common enough in the transplant center at Northwell Health, where sophomore biology major Sahil Rawal works, that the issue has begun to demand attention.
Dr. Bhaskaran and his team have been able to create a classification system to categorize BKV infections after renal transplants, according to Rawal. By analyzing case studies, they were able to establish five grades – low grade transient, low grade intermittent, low grade persistent, high grade transient and high grade persistent – which can be used to help doctors determine a course of action for managing immunosuppression and viral infections.
“Only when a patient is in [the] high grade persistent category would they be taken off the [immunosuppressant] regimens,” Rawal said.
Although they said that their study only included a small sample size, Rawal and Bhaskaran believe that their system may be a useful way to regulate patient recovery. The laboratory plans to continue to study data on BKV and its impact on renal transplant surgeries. They are currently working with a second undisclosed lab to develop vaccines for BKV as a method to circumvent the problem at hand.
“I love studying this material because it provides me with real life situations that physicians face, and it gives me an opportunity to connect with the patient and truly change their life by increasing the knowledge that we have,” Rawal said.