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Related Experiment Video

Updated: Mar 3, 2026

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
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Elevated tacrolimus exposure variability predicts transplant renal insufficiency.

Yue Zhao1, Ying-Xin Zhao2, Di Zhao1

  • 1Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China.

Frontiers in Immunology
|March 2, 2026
PubMed
Summary

High Tacrolimus (TAC) variability and trough concentrations increase renal transplant insufficiency risk. Monitoring TAC exposure is crucial for improving graft survival in kidney transplant recipients.

Keywords:
coefficient of variationpredictiontacrolimustime in therapeutic rangetransplant renal insufficiency

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Area of Science:

  • Nephrology
  • Immunosuppression
  • Transplantation

Background:

  • Optimizing immunosuppression is key for long-term graft survival in renal transplantation.
  • Tacrolimus (TAC) is a vital immunosuppressant, but under- or over-exposure can lead to rejection or renal injury.
  • This study investigates TAC exposure's impact on graft function to identify high-risk post-transplant patients.

Purpose of the Study:

  • To assess the impact of Tacrolimus (TAC) exposure on graft renal function.
  • To identify high-risk individuals for post-transplantation complications.
  • To correlate TAC exposure parameters with renal insufficiency post-transplant.

Main Methods:

  • Retrospective cohort study of adult kidney transplant recipients (2019-2023).
  • Cox regression analysis to evaluate risk effects of TAC exposure parameters (mean, median, STD, CV).
  • Kaplan-Meier method for survival analysis of stabilized graft renal function.

Main Results:

  • Graft renal insufficiency occurred in 19.22% of recipients.
  • A TAC target trough concentration standard deviation (STD) ≥5 showed a 4.55-fold increased risk (p=0.004).
  • Higher TAC coefficient of variation (CV) and lower time in therapeutic range (TTR <0.3) were associated with increased graft renal insufficiency risk.

Conclusions:

  • Elevated TAC trough concentrations, higher CV, and lower TTR significantly increase transplant renal insufficiency risk.
  • Identifying high-risk recipients and optimizing TAC levels are crucial for better outcomes.
  • Interventions to maintain TAC within recommended ranges can improve renal transplant recipient survival.