{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T13:23:54Z","timestamp":1788355434936,"version":"build-2803163510"},"reference-count":26,"publisher":"The Korean Association for the Study of the Liver","issue":"1","license":[{"start":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T00:00:00Z","timestamp":1727827200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/3.0\/"}],"funder":[{"name":"Catholic Medical Center Research Foundation"},{"name":"Institute for Bio-Medical convergence, Incheon St. Mary\u2019s Hospital, The Catholic University of Korea"},{"DOI":"10.13039\/501100003052","name":"Ministry of Trade, Industry and Energy","doi-asserted-by":"publisher","award":["20024163"],"award-info":[{"award-number":["20024163"]}],"id":[{"id":"10.13039\/501100003052","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["RS-2024-00451810"],"award-info":[{"award-number":["RS-2024-00451810"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["e-cmh.org"],"crossmark-restriction":true},"short-container-title":["Clin Mol Hepatol"],"published-print":{"date-parts":[[2025,1,1]]},"abstract":"<jats:p>Background\/Aims: This study aimed to identify the risk factors for chronic kidney disease (CKD) and end-stage renal disease (ESRD) following liver transplantation (LT), with a specific focus on tacrolimus levels and intrapatient variability (IPV).Methods: Among the 1,076 patients who underwent LT between 2000 and 2018, 952 were included in the analysis. The tacrolimus doses and levels were recorded every 3 months, and the IPV was calculated using the coefficient of variability. The cumulative incidence rates of CKD and ESRD were calculated based on baseline kidney function at the time of LT. The impact of tacrolimus levels and their IPV on the development of CKD and ESRD was evaluated, and the significant risk factors were identified.Results: Within a median follow-up of 97.3 months, the 5-year cumulative incidence rates of CKD (0.58 vs. 0.24) and ESRD (0.07 vs. 0.01) were significantly higher in the acute kidney injury group than in the normal glomerular filtration rate (GFR) group. In the normal GFR group, the tacrolimus levels were identified as a risk factor for CKD, with a level of \u22644.5 ng\/mL suggested as optimal for minimizing the risk of CKD. Furthermore, the IPV of tacrolimus levels and doses emerged as a significant risk factor for CKD development in both groups (p&lt;0.05), with tenofovir disoproxil fumarate also being a risk factor in HBV-infected patients. The IPV of tacrolimus levels was also a significant factor in ESRD development (p&lt;0.05).Conclusions: This study elucidated the optimal tacrolimus trough level and highlighted the impact of IPV on the CKD and ESRD development post-LT.<\/jats:p>","DOI":"10.3350\/cmh.2024.0451","type":"journal-article","created":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T08:39:52Z","timestamp":1727858392000},"page":"131-146","update-policy":"https:\/\/doi.org\/10.3350\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Optimal tacrolimus levels for reducing CKD risk and the impact of intrapatient variability on CKD and ESRD development following liver transplantation"],"prefix":"10.3350","volume":"31","author":[{"given":"Soon Kyu","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho 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2012 clinical practice guideline for the evaluation and management of chronic kidney disease","year":"2013"},{"key":"ref20","volume-title":"Cutpoint determination methods in survival analysis using SAS\u00ae: updated %FINDCUT macro","author":"Meyers","year":"2015"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1002\/lt.21821"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2012.04212.x"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-023-10629-3"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1111\/tri.12798"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.12659\/aot.895898"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-022-10320-z"}],"container-title":["Clinical and Molecular 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