Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation · 2026
Tacrolimus Levels 10 Years After Kidney Transplant and Long-Term Clinical Outcomes: A Propensity Score-Matched Analysis.
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Choi Hyunho, Jung Chan Young, Kim Hyosang, Kim Sehee, Ko Youngmin, Kwon Hyunwook, Shin Sung, Kim Young Hoon, Baek Chung Hee
Аннотация
OBJECTIVES: Tacrolimus is a cornerstone immunosuppressant in kidney transplant; however, optimal trough levels during the late maintenance phase remain uncertain. This study investigated the association between tacrolimus trough levels measured 10 to 15 years after transplant and long -term clinical outcomes.
MATERIAL AND METHODS: A retrospective review was conducted of 1747 recipients who received kidney transplants between 1990 and 2005. Among them, 290 patients maintained graft function beyond 15 years with continuous tacrolimus use from post -transplant year 10 to posttransplant year 15. Outcomes were compared between patients with mean tacrolimus trough levels <4 ng /mL and ≥4 ng /mL, with follow -up through December 2024. Propensity score matching was performed using 1 :1 nearest -neighbor matching to balance baseline characteristics.
RESULTS: In the matched cohort (n = 204 ), no significant differences were observed in kidney graft survival or rejection -free survival between groups. Secondary outcomes, including infection, calcineurin inhibitor toxicity, and malignancy, also showed no significant differences, except for a higher incidence of sepsis in the lower -level group (P = .049 ). In the unmatched cohort, the cumulative incidence of de novo donor -specific antibody formation beyond 15 years did not differ significantly, although a lower trend was observed in the higher -level group.
CONCLUSIONS: In long -term kidney transplant recipients with stable graft function, modest differences in tacrolimus trough levels during the late maintenance phase were not significantly associated with graft survival or rejection outcomes. Nonetheless, the observed sepsis risk and the immunological implications of de novo donor -specific antibody formation underscore the importance of personalized tacrolimus exposure strategies and continued immunological surveillance in long-term transplant care.
MATERIAL AND METHODS: A retrospective review was conducted of 1747 recipients who received kidney transplants between 1990 and 2005. Among them, 290 patients maintained graft function beyond 15 years with continuous tacrolimus use from post -transplant year 10 to posttransplant year 15. Outcomes were compared between patients with mean tacrolimus trough levels <4 ng /mL and ≥4 ng /mL, with follow -up through December 2024. Propensity score matching was performed using 1 :1 nearest -neighbor matching to balance baseline characteristics.
RESULTS: In the matched cohort (n = 204 ), no significant differences were observed in kidney graft survival or rejection -free survival between groups. Secondary outcomes, including infection, calcineurin inhibitor toxicity, and malignancy, also showed no significant differences, except for a higher incidence of sepsis in the lower -level group (P = .049 ). In the unmatched cohort, the cumulative incidence of de novo donor -specific antibody formation beyond 15 years did not differ significantly, although a lower trend was observed in the higher -level group.
CONCLUSIONS: In long -term kidney transplant recipients with stable graft function, modest differences in tacrolimus trough levels during the late maintenance phase were not significantly associated with graft survival or rejection outcomes. Nonetheless, the observed sepsis risk and the immunological implications of de novo donor -specific antibody formation underscore the importance of personalized tacrolimus exposure strategies and continued immunological surveillance in long-term transplant care.