{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T06:22:10Z","timestamp":1783059730898,"version":"3.54.6"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Transplant."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Tacrolimus (Tac) is highly bound to erythrocytes, with less than 1% present in the pharmacologically active unbound fraction. In anemia, whole-blood trough concentrations may underestimate effective exposure. Hematocrit (Hct) adjustment has been proposed but clinical outcome data are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a single-center retrospective cohort study of adult liver transplant recipients (2018 to 2022) to examine the relationship between Hct-adjusted Tac and early clinical outcomes. Tac troughs, Hct, and serum creatinine were collected for 90 days. Hct-adjusted Tac was calculated as (0.45 \u00f7 Hct) \u00d7 total Tac. The difference between adjusted and measured Tac (delta Tac) was used to represent anemia-related underestimation and modeled as a time-varying covariate in Cox regression for acute kidney injury (AKI) and biopsy-proven T cell-mediated rejection (TCMR), adjusting for established risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 344 recipients (median age 59 years; 62% male), TCMR occurred in 15.7% and AKI in 69.8%. Delta Tac was not associated with TCMR (HR 0.93, 95% CI 0.77 to 1.14) but was associated with higher AKI hazard (HR 1.15 per ng\/mL, 95% CI 1.08 to 1.24).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>These findings suggest that divergence between Hct-adjusted and measured Tac is associated with increased AKI risk without a corresponding signal for rejection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frtra.2026.1878595","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T05:40:15Z","timestamp":1783057215000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hematocrit-adjusted tacrolimus levels are associated with acute kidney injury but not rejection early after liver transplantation"],"prefix":"10.3389","volume":"5","author":[{"given":"Trana","family":"Hussaini","sequence":"first","affiliation":[{"name":"Pharmaceutical Sciences, University of British Columbia","place":["Vancouver, BC, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daljeet","family":"Chahal","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Faculty of Medicine, University of British Columbia","place":["Vancouver, BC, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimir","family":"Marquez","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Faculty of Medicine, University of British Columbia","place":["Vancouver, BC, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianyi","family":"Wen","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Research Program","place":["Vancouver, BC, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Dahiya","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Faculty of Medicine, University of British Columbia","place":["Vancouver, BC, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric M.","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Faculty of Medicine, University of British Columbia","place":["Vancouver, BC, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Law","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Cumming School of Medicine, University of Calgary","place":["Calgary, AB, Canada"]},{"name":"Centre for Health Policy, O\u2019Brien Institute for Public Health, University of Calgary","place":["Calgary, AB, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1002\/lt.21877","article-title":"Report of the first international liver transplantation society expert panel consensus conference on renal insufficiency in liver transplantation","volume":"15","author":"Charlton","year":"2009","journal-title":"Liver Transpl"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1636","DOI":"10.1097\/TP.0000000000002305","article-title":"Acute kidney injury after liver transplantation","volume":"102","author":"Durand","year":"2018","journal-title":"Transplantation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"372","DOI":"10.3390\/jcm8030372","article-title":"Incidence and impact of acute kidney injury after liver transplantation: a meta-analysis","volume":"8","author":"Thongprayoon","year":"2019","journal-title":"J Clin 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