From the Research
For a cadaveric renal transplant in 2016, the target trough level for tacrolimus should be at least 8 ng/mL during the first month after transplantation to minimize the risk of acute rejection, as evidenced by a study published in 2017 1. This recommendation is based on the study that found that average tacrolimus trough levels of at least 8 ng/mL in the first month after transplantation were associated with a lower risk of biopsy-proven acute rejection during the first 12 months after transplant. The study used receiver operating characteristic curve analysis to determine the optimal target trough level and found that 8 ng/mL was the threshold that best discriminated between patients with and without acute rejection. Key points to consider when managing tacrolimus trough levels include:
- Regular monitoring of renal function, drug interactions, and side effects
- Adjusting trough levels based on individual patient factors such as immunologic risk, concomitant immunosuppression, and presence of rejection episodes
- Maintaining higher levels early post-transplant when rejection risk is highest, and lower levels later to minimize nephrotoxicity and other side effects
- Considering alternative target ranges for patients with delayed graft function, high immunologic risk, or those on certain interacting medications. Overall, the goal is to balance the risk of acute rejection with the risk of drug-induced toxicities, and to individualize treatment based on patient-specific factors 1.