{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T16:29:23Z","timestamp":1778344163286,"version":"3.51.4"},"reference-count":37,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chiesi Espa\u00f1a and Red de Investigaci\u00f3n Cooperativa Orientada a Resultados en Salud","award":["RICORS2040"],"award-info":[{"award-number":["RICORS2040"]}]},{"name":"Chiesi Espa\u00f1a and Red de Investigaci\u00f3n Cooperativa Orientada a Resultados en Salud","award":["RD21\/0005\/0003"],"award-info":[{"award-number":["RD21\/0005\/0003"]}]},{"name":"Instituto de Salud Carlos III and \u201cUni\u00f3n Europea Next Generation EU\/Mecanismo para la Recuperaci\u00f3n y la Resiliencia (MRR)\/PRTR. CERCA Programme\/Generalitat de Catalunya"},{"name":"Instituto de Salud Carlos III (ISCIII), Spain"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background\/Objectives: Tacrolimus is the most used immunosuppressive agent in solid organ transplantation due to its efficacy in preventing acute rejection, but it has a narrow therapeutic range, and overexposure often leads to toxicities, including neurological side effects like tremors. Tremor affects up to 54% of renal transplant patients under tacrolimus. Extended-release tacrolimus (LCPT) has demonstrated efficacy in reducing tremor severity, as evidenced by studies employing quality of life (QoL) questionnaires, the Fahn\u2013Tolosa\u2013Marin (FTM) scale, and Accelerometer devices. The objectives of this study were to evaluate the benefits of the conversion to LCPT formulation in kidney transplant recipients experiencing tremors on prolonged-release tacrolimus (PR-TAC) treatment and to validate the DyCare device, a wearable wireless sensor for tremors. Results: The DyCare device measured tremor frequencies of 8.74 \u00b1 0.11 Hz and 1.36 \u00b1 0.08\u00b0 and 17.38 \u00b1 1.16\u00b0, as root mean square (RMSx100 for accelerometer and Gyroscope, respectively) in PR-TAC patients. After switching ten patients to LCPT, tremor severity significantly decreased, as confirmed by DyCare and the QoL in the Essential Tremor Questionnaire (QUEST). Additionally, LCPT allowed a 34% reduction in tacrolimus dosage while maintaining therapeutic trough concentrations. Immunological and pharmacodynamic biomarkers (p-miR-210-3p, p-IL10, p-IL12p70, p-IFN\u03b3 uCXCL10, NFAT-regulated gene expression) confirmed stable immunosuppression post-conversion. Conclusions: The conversion to the LCPT formulation significantly reduced tremors in kidney transplant recipients without altering their immunological status, as confirmed through a panel of immunologic and pharmacodynamic biomarkers. The DyCare device enables a precise quantification of tremors in transplant recipients, allowing physicians to optimize treatment strategies.<\/jats:p>","DOI":"10.3390\/ph18101488","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T07:57:27Z","timestamp":1759478247000},"page":"1488","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Tacrolimus-Associated Tremor in Renal Transplant Patients: Potential Impact of the Galenic Formulation"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8737-5005","authenticated-orcid":false,"given":"Jordi","family":"Rovira","sequence":"first","affiliation":[{"name":"Nephrology and Transplantation (LENIT), Fundaci\u00f3 Recerca Cl\u00ednic Barcelona-Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (FRCB-IDIBAPS), 08036 Barcelona, Spain"},{"name":"RICORS(RD21-0005-0003), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6861-5832","authenticated-orcid":false,"given":"Olga","family":"Mill\u00e1n","sequence":"additional","affiliation":[{"name":"Pharmacology and Toxicology Section, Centre de Diagn\u00f2stic Biom\u00e8dic (CDB), Hospital Clinic of Barcelona, FRCB-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Biomedical Research Center in Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3381-7503","authenticated-orcid":false,"given":"Pedro","family":"Ventura-Aguiar","sequence":"additional","affiliation":[{"name":"Nephrology and Transplantation (LENIT), Fundaci\u00f3 Recerca Cl\u00ednic Barcelona-Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (FRCB-IDIBAPS), 08036 Barcelona, Spain"},{"name":"RICORS(RD21-0005-0003), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Department of Nephrology and Kidney Transplantation, Institut Cl\u00ednic de Nefrologia I Urologia (ICNU), Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merc\u00e8","family":"Brunet","sequence":"additional","affiliation":[{"name":"Pharmacology and Toxicology Section, Centre de Diagn\u00f2stic Biom\u00e8dic (CDB), Hospital Clinic of Barcelona, FRCB-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain"},{"name":"Biomedical Research Center in Hepatic and Digestive Diseases (CIBEREHD), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6199-3016","authenticated-orcid":false,"given":"Fritz","family":"Diekmann","sequence":"additional","affiliation":[{"name":"Nephrology and Transplantation (LENIT), Fundaci\u00f3 Recerca Cl\u00ednic Barcelona-Institut d\u2019Investigacions Biom\u00e8diques August Pi i Sunyer (FRCB-IDIBAPS), 08036 Barcelona, Spain"},{"name":"RICORS(RD21-0005-0003), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Department of Nephrology and Kidney Transplantation, Institut Cl\u00ednic de Nefrologia I Urologia (ICNU), Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1136\/bmj.38569.471007.AE","article-title":"Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: Meta-analysis and meta-regression of randomised trial data","volume":"331","author":"Webster","year":"2005","journal-title":"Bmj"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"505","DOI":"10.4103\/aian.aian_614_24","article-title":"Neurotoxicity of Calcineurin Inhibitors","volume":"28","author":"Bajon","year":"2025","journal-title":"Ann. 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