Related Experiment Video
Updated: Jan 21, 2026

Mouse Kidney Transplantation: Models of Allograft Rejection
Published on: October 11, 2014
Non-linear Relationship between Tacrolimus Blood Concentration and Acute Rejection After Kidney Transplantation: A
Saifu Yin1,2,3, Turun Song1,2,3, Xingxing Li4
1Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Background:
Maintaining the exposure of tacrolimus (Tac) after kidney transplantation (KT) must be necessary to prevent acute rejection (AR) and improve graft survival,but there is still no clear consensus on the optimal Tac target blood concentration and concentration-effect relationship is poorly defined.
Methods:
We conducted a dose-response meta-analysis to quantitatively assess the association between Tac blood concentration and (AR) or adverse effects after KT. A comprehensive search of PubMed, Embase and Cochrane library databases was conducted to find eligible studies up to 10th September 2018. Unpublished data from patients receiving KT in West China Hospital (Sichuan University, China) were also collected. Both twostage dose-response and one-stage dose-response meta-analysis models were used to improve the statistical power.
Results:
A total of 4967 individuals from 10 original studies and 1453 individuals from West China Hospital were eligible for the ultimate analysis. In the two-stage dose-response meta-analysis model, we observed a significant non-linear relationship between Tac blood concentration and AR (P < 0.001) with moderate heterogeneity (I2 = 46.0%, P = 0.08). Tac blood concentration at 8ng/ml was associated with the lowest risk of AR (RR: 0.26, 95%CI: 0.13 - 0.54) by reference to 2ng/ml. Tac concentration at 7.0 - 11.0 ng/ml reduced the risk of AR by at least 70%, 5-14 ng/ml by at least 60%, and 4.5 - 14 ng/ml at least 50%. In the one-stage dose-response model, we also found a strong non-linear relationship between Tac and AR (P < 0.001) with moderate heterogeneity (I2 = 41.2%, P = 0.10). Tac concentration of 7.5 ng/ml was associated with the lowest risk of AR (RR: 0.35, 95%CI: 0.16 - 0.77). The blood concentration at 5.5 - 9.5 ng/ml was associated with the reduced AR by at least 60% and 4.5 - 10.5 ng/ml by at least 50% by reference to 2 ng/ml.
Conclusion:
Maintaining Tac blood concentration at 5 - 9.5 ng/ml within the first year may prevent AR most effectively.
Related Concept Videos
Dose-Response Relationship: Overview
Dose-Response Relationship: Potency and Efficacy
Dose-Response Relationship: Selectivity and Specificity
Acute Kidney Injury IV: Diagnostic Studies and Prevention
Kidney Transplant I: Introduction
Acute Kidney Injury I: Introduction

