Background: Tacrolimus(Tac) -mycophenolic acid compared to cyclosporine is an independent risk factor for BK virus-associated nephropathy (BKVAN). Cyclosporine A (CsA) can inhibit BKV replication in vitro. Switching from Tac to low-dose CsA is recommended in BKVAN patients, but systematic prospective evaluations were not performed. Methods: Inclusion criteria: (1)2015.01.01[sim]2016.12.31recipients diagnosed as BKVAN by biopsy, (2)serum creatinine (Scr) ≤300[micro]mol/L, (3)without any other treatment before. The immunosuppressive agent was switched from Tac to low-dose CsA (trough level,80-120ng/ml). The following tests were monitored regularly including Scr,BKV,CsA trough level,PRA,et al. Repeat biopsy was performed 6-12 months after switching.(ChiCTR-IOR-17010993) Results: 24 cases were included in the study. At diagnosis,no DSA was detected. By 3 months after switching, viruria and viremia decreased, meanwhile morning UG increased (p<0.01). By one year after switching, compared with diagnosis, the mean Scr was stable,the CsA trough level was 97.9[sim]105ng/ml.All patients cleared viremia with a mean time of 2.65 months.The incidence of cleared viruria was 8.3%(2/24).Repeat biopsies showed rejection occurred in 2 patients. SV40T became negative in 8 (33.3%) patients(10.3±1.8m). The degree of cytopathy (cy) and interstitial inflammation decreased significantly at repeat biopsy.

Conclusion Switching from Tac to low-dose CsA is a safe and effective therapy for BKVAN, as CsA working with some anti-virus effect.

CITATION INFORMATION: Huang G., Chen X., Yang S., Wang C. Prospective Study of Switching from Tacrolimus to Low-Dose Cyclosporine A Preserving Allograft Function in BK Virus-Associated Nephropathy Am J Transplant. 2017;17 (suppl 3).

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