{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T15:57:37Z","timestamp":1781279857023,"version":"3.54.1"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,5]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Compounded tacrolimus suspensions are frequently used in pediatric kidney transplant recipients who cannot reliably swallow capsules or who receive medication via a gastrostomy tube. Clinicians at our center observed unusually flat mini\u2010pharmacokinetic (mini\u2010PK) profiles in patients receiving liquid tacrolimus.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively analyzed 13 tacrolimus mini\u2010PK profiles (C0, C1, C2, C4) from 7 pediatric kidney transplant recipients receiving compounded liquid tacrolimus, measured by LC\u2013MS\/MS in routine clinical care. As a contemporaneous comparator measured by the same assay, we assembled mini\u2010PK profiles from pediatric recipients receiving capsule tacrolimus at our center (December 2024 onward). A historical capsule cohort from Berlin measured with Abbott Tacrolimus II immunoassay was used only as external context.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Contemporary LC\u2013MS\/MS capsule profiles showed the expected early post\u2010dose rise, whereas liquid profiles remained comparatively flat across the 0\u20134\u2009h window. In the historical capsule cohort, higher trough concentrations were associated with lower\n C<\/jats:italic>\n max<\/jats:sub>\n \/C\n min<\/jats:sub>\n ratios, consistent with a trough\u2010dependent change in apparent PK shape.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this Quality Improvement (QI) analysis, pediatric patients receiving compounded liquid tacrolimus demonstrated flatter mini\u2010PK profiles than contemporaneous capsule recipients when evaluated within the same analytical platform. These findings support closer attention to PK shape (not trough alone) in clinically complex children requiring liquid formulations and motivate prospective studies that control for gastrointestinal comorbidity, co\u2010medications, and administration route.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/petr.70326","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T11:47:29Z","timestamp":1777895249000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Flatter Tacrolimus Pharmacokinetic Profiles in Pediatric Kidney Transplant Recipients Receiving Liquid Formulations: A Quality Improvement Study"],"prefix":"10.1111","volume":"30","author":[{"given":"Sarah","family":"Lafond","sequence":"first","affiliation":[{"name":"London Health Sciences Centre Children's Hospital London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6848-8933","authenticated-orcid":false,"given":"Mara","family":"Medeiros\u2010Domingo","sequence":"additional","affiliation":[{"name":"Universidad Nacional Aut\u00f3noma de M\u00e9xico Mexico City Mexico"},{"name":"Hospital Infantil de M\u00e9xico Federico G\u00f3mez Unidad de Investigaci\u00f3n y Diagn\u00f3stico en Nefrolog\u00eda y Metabolismo Mineral \u00d3seo Mexico City Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Henderson","sequence":"additional","affiliation":[{"name":"Department of Pharmacy London Health Sciences Centre London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dua","family":"Fayaz","sequence":"additional","affiliation":[{"name":"Undergraduate Health Sciences Program Western University London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Nichols","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Western University and LHSC London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1891-6765","authenticated-orcid":false,"given":"Guido","family":"Filler","sequence":"additional","affiliation":[{"name":"London Health Sciences Centre Children's Hospital London Ontario Canada"},{"name":"Department of Paediatrics and Medicine Western University London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000000640"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/12.8.1668"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.14879"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.70142"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-004411"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3046.2002.02039.x"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jalm\/jfaf199"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-199529060-00003"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2020.01142"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/bcp.70041"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/TXD.0000000000001439"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/00912700122009999"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/00912700122010104"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000000773"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13328"}],"container-title":["Pediatric 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