Remission of Post Liver Transplant FSGS after Conversion to Ciclosporin-A from FK506 -- 3 Case Reports

Background: FK506 (FK) is the key immunosuppressive drug for orthotropic de novo liver transplantation recipients. It has been shown to be superior to Ciclosporin-A (CsA) in terms of graft survival and toxicity. However, we report of three cases, who developed FSGS in the native kidneys that remitted when FK506 was switched to CsA. Methods: We changed FK506 to CsA in 2 patients keeping the third patient continue FK as before. At timed interval we evaluated renal remission and liver graft status over a long period of 6 years. Both short-term and long-term outcomes in terms of renal and liver were compared. Achievement of 50% reduction of proteinuria (TUP) was the endpoint. Results: Patient characteristics were similar except for the incidence of HCV in the non-converted case. Stable remission of proteinuria and stable renal function were attained in the converted cases, while the 3rd case had increase in proteinuria from 1.44 g/d to 2.25 g/d with deterioration of RFT. There was no episode of AR in the OLTX post conversion as proven by biopsy. Conclusions: CsA may induce remission in FSGS precipitated by FK506 for OLTX without compromising liver graft.