| Title: |
Tacrolimus intrapatient variability and rejection are associated with inferior allograft outcomes after kidney transplantation |
| Authors: |
Maryam Javed; Aruna Sanghera; Azhar Ali Khan; Ria Nagpal; Katie Butler; Abigail Hobill; Alice Gage; Felix Karst; Amy Needleman; Mya Hmun; Nicola Thal; Graham Shirling; Ray Fernando; Gareth Jones; Mark Harber; Rhys D. R. Evans |
| Source: |
Frontiers in Nephrology, Vol 5 (2025) |
| Publisher Information: |
Frontiers Media S.A., 2025. |
| Publication Year: |
2025 |
| Collection: |
LCC:Diseases of the genitourinary system. Urology |
| Subject Terms: |
rejection; adherence; tacrolimus; outcomes; graft failure; Diseases of the genitourinary system. Urology; RC870-923 |
| Description: |
IntroductionEarly kidney transplant failure has significant negative impact for individuals and healthcare systems. Contemporary data investigating early allograft failure are lacking. We undertook a retrospective observational cohort study of adult patients who underwent kidney transplantation at a single European centre.MethodsWe determined causes of allograft failure between 1 and 5 years after transplant and explored clinical variables present at 1 year that predicted allograft loss.Results591 patients (median age 50 years, 64.1% male, and 44% white) were included; 531 (89.8%) had graft survival and 60 (10.2%) had graft loss between 1- and 5-years. Rejection was the primary cause of graft failure in 24 (40%) cases and 54% had undetectable tacrolimus levels prior to failure event. Female sex, serum creatinine at 1 year, the occurrence of rejection, and undetectable tacrolimus levels were associated with increased odds of graft loss. In subsequent analysis of 787 patients alive with a functioning graft at 1 year, recipient age, serum creatinine, proteinuria, any rejection episode, and tacrolimus intrapatient variability (IPV) at 1 yearwere associated with an increased hazard of graft loss.DiscussionHence, graft losses were predominantly alloimmune mediated, often associated with non-adherence, and were predicted by tacrolimus IPV at 1 year. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
2813-0626 |
| Relation: |
https://www.frontiersin.org/articles/10.3389/fneph.2025.1666191/full; https://doaj.org/toc/2813-0626 |
| DOI: |
10.3389/fneph.2025.1666191 |
| Access URL: |
https://doaj.org/article/00a21e6200614e59867c3c8cd161a608 |
| Accession Number: |
edsdoj.00a21e6200614e59867c3c8cd161a608 |
| Database: |
Directory of Open Access Journals |