{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:26:41Z","timestamp":1753878401475,"version":"3.41.2"},"reference-count":12,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Outcomes are poor in kidney transplant (KTx) recipients with sub\u2010therapeutic tacrolimus troughs. It is unknown if rabbit anti\u2010thymocyte globulin (rATG) induction delays the deleterious impact of early sub\u2010therapeutic tacrolimus troughs. The study aims compared short\u2010term graft outcomes of KTx recipients stratified by tacrolimus troughs at the time of discharge from index admission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Single\u2010center retrospective cohort study compared adult KTx recipients with sub\u2010therapeutic versus therapeutic discharge tacrolimus troughs (defined as &lt; vs. \u2265 8\u00a0ng\/mL). Successful primary\/secondary KTx between 10\/2017 and 12\/2019, who received rATG induction and tacrolimus\u2010based immunosuppression and had an index admission length of stay \u22645 days were included. The primary composite outcome analyzed the 3\u2010month risk of rejection, graft loss, or de novo donor\u2010specific antibodies (dnDSA). Cox regression analysis assessed the association of early sub\u2010therapeutic tacrolimus troughs on short\u2010term graft outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 411 recipients included, 335 (81.5%) were discharged with a tacrolimus trough &lt;8 ng\/mL versus 76 (18%) \u22658\u00a0ng\/mL. Our population consisted of 30% black\/non\u2010Hispanic, 10% with a history of previous KTx, 60% deceased donors, and low cPRA (median 0%), which was in the low immunological risk range. No significant difference was identified in the primary outcome (13.4%\u00a0vs. 9.2%, <jats:italic>p<\/jats:italic> = 0.44). Cox regression analysis identified no association between sub\u2010therapeutic tacrolimus troughs at discharge and the primary outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>KTx recipients receiving rATG induction, discharged with sub\u2010therapeutic tacrolimus troughs (&lt;8\u00a0ng\/mL) have comparable short\u2010term graft outcomes versus those discharged with therapeutic troughs (\u22658\u00a0ng\/mL). This suggests that delaying discharge to reach therapeutic troughs is not necessary.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.70156","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T16:07:29Z","timestamp":1744733249000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Decreasing the Risk of Early Sub\u2010Therapeutic Tacrolimus Troughs on Short\u2010Term Outcomes in Low\u2010Moderate Risk Kidney Transplant Recipients Receiving Rabbit Anti\u2010Thymocyte Globulin Induction"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1235-5277","authenticated-orcid":false,"given":"Xinqi","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Pharmacy Services Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4370-3796","authenticated-orcid":false,"given":"Jennifer","family":"Trofe\u2010Clark","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Penn Transplant Institute Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Division of Renal Electrolyte and Hypertension Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Surgery Division of Transplantation Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7903-8295","authenticated-orcid":false,"given":"Deirdre","family":"Sawinski","sequence":"additional","affiliation":[{"name":"Penn Transplant Institute Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Division of Renal Electrolyte and Hypertension Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan","family":"Steiner","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahreen","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Witek","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Penn Transplant Institute Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7295-6261","authenticated-orcid":false,"given":"Tara","family":"Fallah","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Penn Transplant Institute Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4425-1050","authenticated-orcid":false,"given":"Maxwell","family":"Norris","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Hospital of the University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Penn Transplant Institute Hospital of the University of Pennsylvania  Philadelphia Pennsylvania 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