Tacrolimus Intrapatient Variability as a Biomarker in Solid Organ Transplantation

Tacrolimus is the primary calcineurin inhibitor agent prescribed in different solid organ transplantation modalities. Among its characteristics, tacrolimus has a high inter- and intrapatient variability. Recently, tacrolimus intrapatient variability (Tac-IPV) has been proposed as a useful biomarker to predict outcomes in different types of solid organ transplantation. This work includes a systematic review of the literature that evaluates Tac-IPV influence on solid organ transplantation outcomes from inception to September 18, 2024. Although there are several publications assessing the influence of Tac-IPV in transplantation, we found that there is a lack of consensus regarding which is the best measure to evaluate Tac-IPV. Moreover, the ideal post-transplantation period for evaluating this biomarker has not been established so far. Different cut-off points have been proposed, especially in adult kidney transplantation, where most of the studies have been carried out, but these cut-off values may not be applicable to other transplantation modalities. This work includes a description of the main findings of different studies in an attempt to state what the current knowledge on the topic is in different solid organ transplantation modalities.