ArticleEuropean journal of clinical pharmacology2019
Reduction of exposure to tacrolimus trough level variability is associated with better graft survival after kidney transplantation.
Article in European journal of clinical pharmacology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Impact of Intrapatient Immunosuppression Variability in Renal Transplantation Outcomes: A Systematic Review and Meta-analysis.Transplantation · 2026Pooled it
- Exploratory Analysis of the Impact of an mHealth Medication Adherence Intervention on Tacrolimus Trough Concentration Variability: Post Hoc Results of a Randomized Controlled Trial.The Annals of pharmacotherapy · 2020Trial
- The impact of tacrolimus variability on first year renal function in kidney transplant recipients: A retrospective cohort study.Medicine · 2026Article
- Substance Use Patterns in Pediatric Solid Organ Transplant Candidates: Impact After Transplant.Pediatric transplantation · 2026Article
- Elevated tacrolimus exposure variability predicts transplant renal insufficiency.Frontiers in immunology · 2026Article
- The importance of staying within range: associations between tacrolimus intrapatient variability and kidney transplant outcomes.Frontiers in immunology · 2026Article
- Tacrolimus intrapatient variability and rejection are associated with inferior allograft outcomes after kidney transplantation.Frontiers in nephrology · 2025Article
- Population pharmacokinetic modeling of missed mycophenolate mofetil doses: Impact on exposure and exploration of mitigation strategies.PloS one · 2025Article
- Long-Term Outcomes with Prolonged-Release Tacrolimus in Kidney Transplantation: A Retrospective Real-World Data Analysis.Annals of transplantation · 2024Article
- Immunosuppressant nonadherence profile in kidney transplant recipients and the impact of medication adherence on transplant outcomes.Frontiers in pharmacology · 2024Article
- Impact of tacrolimus intra-patient variability in adverse outcomes after organ transplantation.World journal of transplantation · 2023Review
- Improving adherence to immunosuppression after liver or kidney transplantation in individuals with impairments in personality functioning - A randomized controlled single center feasibility study.Frontiers in psychology · 2023Article
- Association of intraindividual tacrolimus variability with de novo donor-specific HLA antibody development and allograft rejection in pediatric kidney transplant recipients with low immunological risk.Pediatric nephrology (Berlin, Germany) · 2022Article
- Tacrolimus Intrapatient Variability After Switching From Immediate or Prolonged-Release to Extended-Release Formulation, After an Organ Transplantation.Frontiers in pharmacology · 2021Article
- Intrapatient Variability in Tacrolimus Trough Levels Over 2 Years Affects Long-Term Allograft Outcomes of Kidney Transplantation.Frontiers in immunology · 2021Observational
- Combined Effect of Inter- and Intrapatient Variability in Tacrolimus Exposure on Graft Impairment Within a 3-Year Period Following Kidney Transplantation: A Single-Center Experience.European journal of drug metabolism and pharmacokinetics · 2020Article
- A comprehensive review of the impact of tacrolimus intrapatient variability on clinical outcomes in kidney transplantation.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2020Review
- Meeting Regulatory Requirements for Drugs with a Narrow Therapeutic Index: Bioequivalence Studies of Generic Once-Daily Tacrolimus.Drug, healthcare and patient safety · 2020Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
purposeHigh tacrolimus trough drug level variability was found to be associated with reduced graft survival. The primary goal of this study was to find whether reduction of exposure to high tacrolimus trough level variability in patients in which previously had high variability was associated with better graft survival.
methodsAll tacrolimus drug level values in patients that underwent kidney transplantation at our center between 2006 and 2015 were collected. Exposure to variability was calculated using a time-weighted coefficient of variability (TWCV). Time-dependent univariate and multivariate Cox proportional hazard models were used to analyze the primary outcome of graft survival and to determine a cutoff value for TWCV as a predictor of this outcome.
resultsA total of 878 patients were included in the study with a median follow-up of 1263 days. TWCV above 25% was significantly associated with reduced graft survival (HR3.66, 95% CI 2.3-5.8, p < 0.001). Of the 480 patients (54.7%) who had a cumulative TWCV of > 25% at a certain time during the follow-up, 110 (22.9%) later returned to a cumulative TWCV of less than 25%. Reduction of TWCV to values below 25% was associated with a hazard of graft loss that was not different from patients who had cumulative TWCV of less than 25% during the entire follow-up period (HR 1.81, 95% CI 0.71-4.62, p = 0.218 and HR 1.08, 95% CI 0.39-2.99, p = 0.780) in univariate and multivariate analyses, respectively.
conclusionsMonitoring TWCV can help detect the high-risk patients. Interventions intended to reduce variability on long-term graft survival may have a positive effect on graft survival.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.