Impact of tacrolimus intra-patient variability in adverse outcomes after organ transplantation

Abstract

Tacrolimus (Tac) is currently the most common calcineurin-inhibitor employed in solid organ transplantation. High intra-patient variability (IPV) of Tac (Tac IPV) has been associated with an increased risk of immune-mediated rejection and poor outcomes after kidney transplantation. Few data are available concerning the impact of high Tac IPV in non-kidney transplants. However, even in kidney transplantation, there is still a controversy whether high Tac IPV is indeed detrimental in respect to graft and/or patient survival. This may be due to different methods employed to evaluate IPV and distinct time frames adopted to assess graft and patient survival in those reports published up to now in the literature. Little is also known about the influence of high Tac IPV in the development of other untoward adverse events, update of the current knowledge regarding the impact of Tac IPV in different outcomes following kidney, liver, heart, lung, and pancreas transplantation to better evaluate its use in clinical practice.

Keywords: Tacrolimus; Intra-patient variability; Rejection; Organ transplantation; Graft survival; Outcomes

Core Tip: Tacrolimus is widely used after solid organ transplantation. High intra-patient variability of tacrolimus (Tac IPV) has been associated with poor graft and patient survival. This review summarizes current evidence regarding the impact of high Tac IPV in several outcomes after kidney, liver, heart, lung and pancreas transplantation.