From the FDA Drug Label
Most patients are stable when trough whole blood concentrations are maintained between 5 to 20 ng/mL. Long-term post-transplant patients are often maintained at the low end of this target range.
The target trough level of Prograf (tacrolimus) 4 years after kidney transplant is likely at the low end of the range of 5 to 20 ng/mL. 1
From the Research
For a kidney transplant recipient 4 years post-transplantation, the target trough level of Prograf (tacrolimus) should be around 3-5 ng/mL, as levels higher than 6 ng/mL may not be required for stable patients, according to the most recent study 2. This recommendation is based on the study published in 2020, which found that tacrolimus trough levels higher than 6 ng/mL might not be required after a year in stable kidney transplant recipients, with no significant differences in renal and cardiovascular outcomes, opportunistic infections, and renal allograft function between patients with low-level and high-level tacrolimus 2. Some key points to consider when managing tacrolimus levels in kidney transplant recipients include:
- Monitoring levels regularly, typically every 1-3 months in stable patients, with blood draws occurring 12 hours after the last dose (trough level) 3
- Adjusting doses based on individual risk factors, such as previous rejection episodes, medication regimen, and overall immunosuppression strategy 4
- Maintaining consistent timing of medication administration and notifying the transplant team of any significant changes in health status that might necessitate dose adjustments 5
- Being aware of potential drug interactions that can significantly affect tacrolimus levels 6 It's essential to balance the prevention of organ rejection with minimizing long-term tacrolimus toxicity, including nephrotoxicity, neurotoxicity, and metabolic complications, and to individualize treatment based on each patient's unique needs and risk factors.