{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:47:15Z","timestamp":1791823635391,"version":"4.3.4"},"reference-count":29,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Nephrol"],"abstract":"<jats:p>Introduction: There is no consensus on the optimal metric for long-term tacrolimus monitoring after kidney transplantation. It remains unknown how tacrolimus exposure changes over time and how tacrolimus monitoring metrics are related to long-term outcomes. Methods: We examined tacrolimus exposure beyond the first year after kidney transplantation, as assessed by multiple monitoring metrics (i.e., mean trough level, intra-patient variability [IPV], time in therapeutic range, time below range, time above range), in the Wisconsin Allograft Recipient Database. We examined associations of these metrics with late graft outcomes (late rejection, uncensored and death-censored graft failure [DCGF]) and mortality (death with a functioning graft [DWFG]). Results: A total of 1994 kidney transplant recipients, who received tacrolimus-based immunosuppression and survived at least 12 months with a functioning graft, were included. We observed a decreasing trend of tacrolimus exposure over median follow-up of 5.3 years. A high tacrolimus IPV (coefficient of variation \u226530%) in the second year was most strongly associated with outcomes, including a 45% higher risk of uncensored graft failure (adjusted hazard ratio = 1.45; 95% confidence interval: 1.22, 1.72; p &lt; 0.01). A higher IPV also was associated with a higher risk of DCGF, mortality, and late rejection. Cumulative high tacrolimus IPV in the past 5 years was associated with higher risk of graft failure and mortality. Conclusion: Metrics of tacrolimus exposure assessed beyond the first year after kidney transplantation, especially IPV, remain informative for long-term outcomes.<\/jats:p>","DOI":"10.1159\/000552040","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T16:00:28Z","timestamp":1788364828000},"page":"1-16","source":"Crossref","is-referenced-by-count":0,"title":["Monitoring Long-Term Tacrolimus Exposure: Metrics, Trajectories, and Associations with Outcomes after Kidney Transplantation in the Wisconsin Allograft Recipient Database"],"prefix":"10.1159","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-5545-3925","authenticated-orcid":false,"given":"Zhongyu","family":"Yuan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1667-7465","authenticated-orcid":false,"given":"Sandesh","family":"Parajuli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Mandelbrot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brad C.","family":"Astor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfz053"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.semnephrol.2023.151486"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.32585"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2008.02519.x"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03840.x"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000003012"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2020081215"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2024.01.010"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000000640"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2012.01727.x"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1111\/tri.12798"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13803"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001040"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1097\/TXD.0000000000000710"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002913"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14504"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0000000000000881"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-023-03188-0"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2014530"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1208\/s12248-012-9406-x"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3701"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2102953"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1007\/s40620-015-0230-0"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001129"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15199"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15346"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1016\/j.trre.2015.01.002"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2022.09.013"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002760"}],"container-title":["American Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/000552040","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:01:31Z","timestamp":1791820891000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000552040"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":29,"URL":"https:\/\/doi.org\/10.1159\/000552040","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.33415153","asserted-by":"subject"}]},"ISSN":["0250-8095","1421-9670"],"issn-type":[{"value":"0250-8095","type":"print"},{"value":"1421-9670","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,2]]}}}