The optimal approach for IS reduction in renal transplant recipients with BKN is not well defined. A number of clinical and in vitro studies suggest that tacrolimus (TAC) is more strongly associated with viral replication compared to mycophenolate (MPA). Therefore, it has been suggested that contrary to common practice of MPA reduction as first, step, TAC needs to be modified. In this retrospective cohort study we compared the effect of 3 different approaches in 63 patients in our center: MPA reduction first, TAC reduction first, and reduction of both, on resolution of viremia, risk of rejection and graft survival.

Results: The patient demographics, rate of T-cell mediated (TCMR) or any rejection after IS reduction, and graft failure are summarized in the table.

The KM estimates of viremia resolution and graft failure after IS are shown.Our observation suggest that IS reduction by decreasing either MPA or TAC first or both together does not change the rate of viral clearance. Although there was a lower rate of rejection in TAC reduction 1^st cohort, the difference was not significant. Interestingly, we observed a higher risk of graft loss with TAC first, however, other confounding factors have not been accounted for. Further studies are needed to define the optimal approach in IS reduction for treatment of BKN.

CITATION INFORMATION: Ahmed H, Roche-Recinos A, Drachenberg C, Ugarte R, Costa N, Mavanur M, Thomas B, Haririan A. Immunosuppressive Regimen Modification Approaches in BK Nephropathy – A Comparative Study. Am J Transplant. 2017;17 (suppl 3).

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