In general, we would reduce immunosuppression as much as possible. We do not switch Tac to CSA at our center if the patient is on Tac but run the levels low as much as possible. We are more likely to stop the antimetabolite especially if the patient is EBV PCR positive and/or is undergoing addition...

Agree with Dr. Ong. I would not change the calcineurin inhibitor to cyclosporine but would decrease the target tacrolimus level to 3-5 ng/ml. Would decrease the antimetabolite by 50% and if chemotherapy is going to be used would discontinue the antimetabolite. 

I agree with Dr. Ong. We stop the antimetabolite, run the tacrolimus low (4-6 ng/ml) and maintain prednisone 7.5-10 mg. Treatment for PTLD with rituximab or otherwise will add to the overall immunosuppression the patient is receiving. 

Tough questions, I concur with what both Drs. @Ong and @Adey had recommended. In the grand scheme of things, changing from tac to CSA probably isn't enough of a lowering of immunosuppression for PTLD. Our groups reported beneficial effects of switching from Tacrolimus to mTORI (i.e. sirolimus) given...