{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:36:44Z","timestamp":1760060204126,"version":"build-2065373602"},"reference-count":18,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cNational Institute of Health\u201d(NIH) research project","award":["2014-ER6301-00","2014-ER6301-01","2014-ER6301-02","2017-ER6301-00","2017-ER6301-01","2017-ER6301-02","2020-ER7201-00","2020-ER7201-01","2020-ER7201-02","2023-ER0805-00","2023-ER0805-01","1711196703","RS-2023-00255063"],"award-info":[{"award-number":["2014-ER6301-00","2014-ER6301-01","2014-ER6301-02","2017-ER6301-00","2017-ER6301-01","2017-ER6301-02","2020-ER7201-00","2020-ER7201-01","2020-ER7201-02","2023-ER0805-00","2023-ER0805-01","1711196703","RS-2023-00255063"]}]},{"name":"Korea Medical Device Development Fund grant","award":["2014-ER6301-00","2014-ER6301-01","2014-ER6301-02","2017-ER6301-00","2017-ER6301-01","2017-ER6301-02","2020-ER7201-00","2020-ER7201-01","2020-ER7201-02","2023-ER0805-00","2023-ER0805-01","1711196703","RS-2023-00255063"],"award-info":[{"award-number":["2014-ER6301-00","2014-ER6301-01","2014-ER6301-02","2017-ER6301-00","2017-ER6301-01","2017-ER6301-02","2020-ER7201-00","2020-ER7201-01","2020-ER7201-02","2023-ER0805-00","2023-ER0805-01","1711196703","RS-2023-00255063"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Tacrolimus is a cornerstone immunosuppressant in kidney transplantation (KT), but its narrow therapeutic index necessitates precise monitoring. Early post-transplant tacrolimus trough concentrations (C0) are critical, as suboptimal levels can increase rejection and infection risks. This study evaluated the impact of C0 levels at discharge on early post-transplant outcomes in a large Korean cohort. Materials and Methods: This retrospective analysis included 5293 KT recipients from the Korean Organ Transplant Registry (KOTRY) who received a kidney transplant between 2014 and 2019. Recipients were categorized into three groups based on C0 levels at discharge: &lt;5.9 ng\/mL, 5.9\u20139.5 ng\/mL, and &gt;9.5 ng\/mL. Clinical outcomes, including serum creatinine (sCr), biopsy-proven acute rejection (BPAR), and infections requiring hospitalization, were analyzed using the Kruskal\u2013Wallis test and chi-squared test. Results: The BPAR rates were 22.5%, 20.9%, and 21.5% for the low, middle, and high C0 groups, respectively (p = 0.221). However, the incidence of infections requiring hospitalization was significantly higher in the high C0 group (28.1%) compared to the middle (23.9%) and low (21.7%) groups at 1-year follow-up (p &lt; 0.001). In high-risk recipients, lower C0 levels correlated with increased BPAR rates (33.9% vs. 29.1% and 26.4%, p = 0.030). Higher intrapatient variability (IPV) between discharge and 6 months was linked to higher infection risk in all recipients and increased BPAR and infection risk in high-risk patients. Conclusions: Optimal C0 levels at discharge are essential to balance rejection and infection risks in KT. Lower C0 levels and higher IPV increase the risk of adverse outcomes, especially in high-risk sensitized recipients, underscoring the need for careful monitoring and personalized management.<\/jats:p>","DOI":"10.3390\/jcm14165707","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T16:30:36Z","timestamp":1755016236000},"page":"5707","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Tacrolimus Trough Levels at Discharge on Early Post-Kidney Transplantation Outcomes: A Nationwide Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2530-4388","authenticated-orcid":false,"given":"Heungman","family":"Jun","sequence":"first","affiliation":[{"name":"Division of Transplantation and Vascular Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Koryodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7294-0160","authenticated-orcid":false,"given":"Young Ju","family":"Oh","sequence":"additional","affiliation":[{"name":"Division of Transplantation and Vascular Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Koryodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0332-2326","authenticated-orcid":false,"given":"Hyo Kee","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8047-4190","authenticated-orcid":false,"given":"Jun Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju 26426, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yeong Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Inje University Busan Paik Hospital, Busan 47392, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joong Kyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Bongseng Memorial Hospital, Busan 48773, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaeseok","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8975-8381","authenticated-orcid":false,"given":"Myoung Soo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0776-8202","authenticated-orcid":false,"given":"Cheol Woong","family":"Jung","sequence":"additional","affiliation":[{"name":"Division of Transplantation and Vascular Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Koryodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Korean Organ Transplantation Registry Study Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1097\/TP.0000000000001243","article-title":"Calcineurin Inhibitor Nephrotoxicity Through the Lens of Longitudinal Histology: Comparison of Cyclosporine and Tacrolimus Eras","volume":"100","author":"Nankivell","year":"2016","journal-title":"Transplantation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.1016\/j.ajt.2023.02.004","article-title":"OPTN\/SRTR 2021 Annual Data Report: Kidney","volume":"23","author":"Lentine","year":"2023","journal-title":"Am. 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