Clinical Impact of MeltDose Technology Extended-Release Tacrolimus (LCPT) in Solid Organ Transplantation: A Systematic Review.

Tacrolimus is a narrow-therapeutic-index immunosuppressant whose clinical performance is XR®Envarsus XR®), an extended-release tacrolimus formulation, was developed to enhance dissolution, improve bioavailability, and reduce pharmacokinetic variability. This systematic review evaluated the clinical and translational impact of LCPT compared with immediate-release tacrolimus (IR-Tac) across solid-organ transplantation. A systematic search of PubMed/MEDLINE and Google Scholar was conducted from database inception through October 2025. Owing to heterogeneity in study populations, designs, and outcome reporting, a quantitative meta-analysis was not performed, and findings were synthesized qualitatively. Of 351 identified records, 326 underwent screening, and six studies met inclusion criteria. The primary outcome was biopsy-proven acute rejection (BPAR); secondary outcomes included graft survival, mortality, renal function, metabolic complications, adverse events, and tacrolimus trough concentrations. Across studies, LCPT demonstrated clinical efficacy comparable to IR-Tac. In de novo kidney transplantation, BPAR rates were similar (13.1% vs 13.5%), with comparable graft survival and mortality. In heart transplantation, LCPT maintained noninferior outcomes (BPAR 15% vs 10%). In conversion settings, rejection rates remained comparable. LCPT consistently achieved therapeutic trough concentrations with approximately 20-30% lower total daily doses, reflecting enhanced bioavailability attributable to MeltDose technology. These findings support LCPT as a formulation-driven optimization of tacrolimus delivery. While pharmacokinetic advantages are evident, their translation into superior long-term clinical outcomes remains to be fully established.