Optimal control of immunosuppressants in renal transplant recipients susceptible to BKV infection: Optimal control of immunosuppressants in renal transplant recipients susceptible to BKV infection

Kidney transplant recipients are put on a lifelong regime of immunosuppressants to prevent the body from rejecting the allograft. Suppressing the immune system renders the body susceptible to infections. The key to a successful transplant is to ensure the immune system is sufficiently suppressed to prevent organ rejection but adequately strong to fight infections. Finding the optimal balance between over and undersuppression of the immune response is crucial in preventing allograft failure. In this paper, we design a feedback control formulation to predict the optimal amount of immunosuppression required by renal transplant recipients in the context of infections caused by BK virus. We use a receding horizon control methodology to construct the feedback control. Data, as they are currently collected, provide information for only some model states, so we use nonlinear Kalman filtering to estimate the remaining model states for feedback control. We conclude that, using the presented methodology, an individualized adaptive treatment schedule can be built for renal transplant recipients.