ArticlePharmacotherapy2015
African-American race modifies the influence of tacrolimus concentrations on acute rejection and toxicity in kidney transplant recipients.
Article in Pharmacotherapy, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 53 citations in OpenAlex.
- A Novel Laboratory-Developed Test Using Multiplex qPCR to Further Personalize Tacrolimus Dosing.International journal of molecular sciences · 2026Article
- Kidney transplantation in obese Black patients: Strategies to improve access and outcomes.World journal of nephrology · 2026Review
- Multifaceted Intervention to Improve Graft Outcome Disparities in African American Kidney Transplants (MITIGAAT Study): Protocol for a Randomized Controlled Trial.JMIR research protocols · 2024Article
- Does the Tacrolimus Trough Level Adequately Predict Drug Exposure in Patients Requiring a High Tacrolimus Dose?Transplantation direct · 2023Article
- Improving Access to HLA-Matched Kidney Transplants for African American Patients.Frontiers in immunology · 2022Article
- Ethnicity-based classifications and medical genetics: One Health approaches from a Western Pacific perspective.Frontiers in genetics · 2022Review
- Pancreas Transplantation in Black, Asian and Minority Ethnic Patients-Single Centre Experience in the UK.Transplant international : official journal of the European Society for Organ Transplantation · 2022Article
- Increased Incidence of Chronic Kidney Injury in African Americans Following Cardiac Transplantation.Journal of racial and ethnic health disparities · 2021Article
- Recipient APOL1 risk alleles associate with death-censored renal allograft survival and rejection episodes.The Journal of clinical investigation · 2021Article
- Clinical Implications of Tacrolimus Time in Therapeutic Range and Intrapatient Variability in Urban Renal Transplant Recipients Undergoing Early Corticosteroid Withdrawal.Transplantation direct · 2021Article
- Genetic Polymorphisms Affecting Tacrolimus Metabolism and the Relationship to Post-Transplant Outcomes in Kidney Transplant Recipients.Pharmacogenomics and personalized medicine · 2021Article
- The Clinical Impact of the CFrontiers in pharmacology · 2020Review
- Fast Tac Metabolizers at Risk ⁻ It is Time for a C/D Ratio Calculation.Journal of clinical medicine · 2019Article
- Donor and Recipient Ethnicity Impacts Renal Graft Adverse Outcomes.Journal of racial and ethnic health disparities · 2018Article
- Racial and Ethnic Differences in Graft Loss Among Female Liver Transplant Recipients.Transplantation proceedings · 2018Article
- Novel urinary exosomal biomarkers of acute T cell-mediated rejection in kidney transplant recipients: A cross-sectional study.PloS one · 2018Article
- Tacrolimus Trough Concentration Variability and Disparities in African American Kidney Transplantation.Transplantation · 2017Article
- Outcome disparities between African Americans and Caucasians in contemporary kidney transplant recipients.American journal of surgery · 2017Article
- Impact of Cardiovascular Risk Factors on Graft Outcome Disparities in Black Kidney Transplant Recipients.Hypertension (Dallas, Tex. : 1979) · 2016Article
- Genomewide Association Study of Tacrolimus Concentrations in African American Kidney Transplant Recipients Identifies Multiple CYP3A5 Alleles.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2016Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
STUDY
objectiveTo determine the effect of tacrolimus trough concentrations on clinical outcomes in kidney transplantation, while assessing if African-American (AA) race modifies these associations.
designRetrospective longitudinal cohort study of solitary adult kidney transplants.
settingLarge tertiary care transplant center. PATIENTS: Adult solitary kidney transplant recipients (n=1078) who were AA (n=567) or non-AA (n=511). EXPOSURE: Mean and regressed slope of tacrolimus trough concentrations. Subtherapeutic concentrations were lower than 8 ng/ml. MEASUREMENTS AND MAIN
resultsAA patients were 1.7 times less likely than non-AA patients to achieve therapeutic tacrolimus concentrations (8 ng/ml or higher) during the first year after kidney transplant (35% vs 21%, respectively, p<0.001). AAs not achieving therapeutic concentrations were 2.4 times more likely to have acute cellular rejection (ACR) as compared with AAs achieving therapeutic concentrations (20.8% vs 8.5%, respectively, p<0.01) and 2.5 times more likely to have antibody-mediated rejection (AMR; 8.9% vs 3.6%, respectively, p<0.01). Rates of ACR (8.3% vs 6.7%) and AMR (2.0% vs 0.9% p=0.131) were similar in non-AAs compared across tacrolimus concentration groups. Multivariate modeling confirmed these findings and demonstrated that AAs with low tacrolimus exposure experienced a mild protective effect for the development of interstitial fibrosis/tubular atrophy (IF/TA; hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.47-1.32) with the opposite demonstrated in non-AAs (HR 2.2, 95% CI 0.90-5.1).
conclusionIn contradistinction to non-AAs, AAs who achieve therapeutic tacrolimus concentrations have substantially lower acute rejection rates but are at risk of developing IF/TA. These findings may reflect modifiable time-dependent racial differences in the concentration-effect relationship of tacrolimus. Achievement of therapeutic tacrolimus trough concentrations, potentially through genotyping and more aggressive dosing and monitoring, is essential to minimize the risk of acute rejection in AA kidney transplant recipients.
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