{"doi":"10.3390/jcm14165707","title":"Impact of Tacrolimus Trough Levels at Discharge on Early Post-Kidney Transplantation Outcomes: A Nationwide Cohort Study","abstract":"Introduction: Tacrolimus is a cornerstone immunosuppressant in kidney transplantation (KT), but its narrow therapeutic index necessitates precise monitoring. Early post-transplant tacrolimus trough concentrations (C0) are critical, as suboptimal levels can increase rejection and infection risks. This study evaluated the impact of C0 levels at discharge on early post-transplant outcomes in a large Korean cohort. Materials and Methods: This retrospective analysis included 5293 KT recipients from the Korean Organ Transplant Registry (KOTRY) who received a kidney transplant between 2014 and 2019. Recipients were categorized into three groups based on C0 levels at discharge: <5.9 ng/mL, 5.9–9.5 ng/mL, and >9.5 ng/mL. Clinical outcomes, including serum creatinine (sCr), biopsy-proven acute rejection (BPAR), and infections requiring hospitalization, were analyzed using the Kruskal–Wallis test and chi-squared test. Results: The BPAR rates were 22.5%, 20.9%, and 21.5% for the low, middle, and high C0 groups, respectively (p = 0.221). However, the incidence of infections requiring hospitalization was significantly higher in the high C0 group (28.1%) compared to the middle (23.9%) and low (21.7%) groups at 1-year follow-up (p < 0.001). In high-risk recipients, lower C0 levels correlated with increased BPAR rates (33.9% vs. 29.1% and 26.4%, p = 0.030). Higher intrapatient variability (IPV) between discharge and 6 months was linked to higher infection risk in all recipients and increased BPAR and infection risk in high-risk patients. Conclusions: Optimal C0 levels at discharge are essential to balance rejection and infection risks in KT. Lower C0 levels and higher IPV increase the risk of adverse outcomes, especially in high-risk sensitized recipients, underscoring the need for careful monitoring and personalized management.","journal":"Journal of Clinical Medicine","year":2025,"id":572276,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9539,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1478482,"name":"Young Ju Oh","orcid":"0000-0002-7294-0160","position":1,"is_corresponding":false},{"id":1478483,"name":"Hyo Kee Kim","orcid":"0000-0002-0332-2326","position":2,"is_corresponding":false},{"id":1041772,"name":"Jun Young Lee","orcid":"0000-0001-8047-4190","position":3,"is_corresponding":false},{"id":1478484,"name":"Yeong Hoon Kim","orcid":"0000-0002-6849-9368","position":4,"is_corresponding":false},{"id":1478922,"name":"Joong Kyung Kim","orcid":null,"position":5,"is_corresponding":false},{"id":1445347,"name":"Jaeseok Yang","orcid":null,"position":6,"is_corresponding":false},{"id":547131,"name":"Myoung Soo Kim","orcid":"0000-0002-8975-8381","position":7,"is_corresponding":false},{"id":1478485,"name":"Cheol Woong Jung","orcid":"0000-0002-0776-8202","position":8,"is_corresponding":false},{"id":1478923,"name":"Korean Organ Transplantation Registry Study Group","orcid":null,"position":9,"is_corresponding":false},{"id":1478481,"name":"Heungman Jun","orcid":"0000-0003-2530-4388","position":0,"is_corresponding":true}],"reference_count":18,"raw_metadata":null,"created_at":"2026-07-19T02:57:23.653298Z","pmid":"40869532","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}