Immunosuppresents

For any of the post-transplant patients with recurrent HCV, what tack do you take with the drugs if the hcv is damaging the liver?  I understand to keep, say, tacrilimus in the theraputic range of 5 to 8 or whatever, but what about Mcyrophelate, couldn't it be tapered somewhat?  Do you ever taper tacrilimus?  If drugs are lowered and there's a rejection, can you raise them back up and control it or can the rejection get out of control?

[Thomas D Schiano, MD]

its always a good idea to taper medications as judiciously as possible but baseline immunosuppression may not be that detrimental to the recurrence of the HCV--developing a rejection could be if the meds are lowered too much.