{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T01:14:12Z","timestamp":1769044452872,"version":"3.49.0"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceutics"],"abstract":"<jats:p>Background: Kidney transplantation outcomes in resource-limited settings remain underreported. This 10-year retrospective review examined the clinical characteristics, long-term pharmacokinetics, and outcomes of kidney transplant recipients at a South African public hospital. Methods: Data from kidney transplant recipients between January 2012 and December 2022 were analysed. Graft and patient survival were assessed using Kaplan\u2013Meier analysis. Cox proportional hazards models were used to evaluate the associations between clinical and pharmacokinetic variables and outcomes. Results: The one- and five-year graft survival rates were 87.9% and 65.6%, respectively. Acute rejection, as confirmed by biopsy, was associated with graft failure (HR, 2.46; p = 0.010). Increasing recipient age at transplantation increased the graft failure risk by about 5.0% per year (HR: 1.05, p = 0.006). Tacrolimus trough and normalised trough levels were lower in the graft loss group 73% and 93% of the time, respectively, despite similar tacrolimus doses. Whereas achieving optimal tacrolimus concentration did not significantly affect graft survival, maintaining a haemoglobin level &gt;10 g\/dL improved the chances of 3-, 4-, and 5-year graft survival (p-value, 0.001, 0.001, and &lt;0.001, respectively). Patient survival rates were more favourable than graft survival rates. The 1-year and 5-year patient survival rates were 90.0% and 77.4%, respectively. Conclusions: This study offers insights into transplant outcomes in low-resource public health settings. The findings emphasise the impact of rejection and age on the risk of graft failure and the significance of maintaining adequate haemoglobin levels after transplantation. The results also indicate the need for more nuanced and personalised approaches to tacrolimus monitoring in the long-term following transplantation.<\/jats:p>","DOI":"10.3390\/pharmaceutics18010132","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T11:11:17Z","timestamp":1768993877000},"page":"132","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Characteristics, Long-Term Pharmacokinetics, and Outcomes in Kidney Transplant Recipients from an African Tertiary Centre: A 10-Year Single-Centre Retrospective Review"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3789-5326","authenticated-orcid":false,"given":"Sadiq Aliyu","family":"Hussaini","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"},{"name":"Department of Medicine, Ibrahim Badamasi Babangida University, Lapai 911101, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4080-624X","authenticated-orcid":false,"given":"Caroline","family":"Dickens","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Confidence","family":"Makgoro","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7593-0857","authenticated-orcid":false,"given":"Therese","family":"Dix-Peek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Badar","family":"Munir","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6146-6414","authenticated-orcid":false,"given":"Jeevan","family":"Perumala","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4537-7829","authenticated-orcid":false,"given":"Simran","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4530-2667","authenticated-orcid":false,"given":"Qaiser","family":"Goolam","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8274-1157","authenticated-orcid":false,"given":"Graham","family":"Paget","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bala","family":"Waziri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"},{"name":"Department of Medicine, Ibrahim Badamasi Babangida University, Lapai 911101, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2750-2062","authenticated-orcid":false,"given":"Raquel","family":"Duarte","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1111\/j.1600-6143.2011.03686.x","article-title":"Systematic review: Kidney transplantation compared with dialysis in clinically relevant outcomes","volume":"11","author":"Tonelli","year":"2011","journal-title":"Am. J. Transplant."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Wyld, M., Morton, R.L., Hayen, A., Howard, K., and Webster, A.C. (2012). A systematic review and meta-analysis of utility-based quality of life in chronic kidney disease treatments. PLoS Med.","DOI":"10.1371\/journal.pmed.1001307"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.34067\/KID.0000000000000489","article-title":"The Future of Kidney Care in Low and Middle-Income Countries: Challenges, Triumphs and Opportunities","volume":"5","author":"Kalyesubula","year":"2024","journal-title":"Kidney360"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1007\/s00467-023-06129-z","article-title":"Kidney transplantation in low-and middle-income countries: The Transplant Links experience","volume":"39","author":"Roberts","year":"2024","journal-title":"Pediatr. Nephrol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"172","DOI":"10.7196\/SAMJ.2016.v106i2.10190","article-title":"Favourable outcomes for the first 10 years of kidney and pancreas transplantation at Wits Donald Gordon Medical Centre, Johannesburg, South Africa","volume":"106","author":"Fabian","year":"2016","journal-title":"S. Afr. Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"799","DOI":"10.7196\/SAMJ.8627","article-title":"Paediatric liver transplantation in Johannesburg revisited: 59 transplants and challenges met","volume":"104","author":"Loveland","year":"2014","journal-title":"S. Afr. Med. J."},{"key":"ref_7","first-page":"59","article-title":"Effect of dialysis modality on kidney transplant outcomes in South Africa: A single-centre experience","volume":"28","author":"Boosi","year":"2025","journal-title":"Afr. J. Nephrol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Davidson, B., Du Toit, T., Jones, E.S., Barday, Z., Manning, K., Mc Curdie, F., Thomson, D., Rayner, B.L., Muller, E., and Wearne, N. (2019). Outcomes and challenges of a kidney transplant programme at Groote Schuur Hospital, Cape Town: A South African perspective. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0211189"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.2215\/CJN.13440820","article-title":"Introduction to kidney transplantation: Long-term management challenges","volume":"16","author":"Sawinski","year":"2021","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s40620-016-0316-3","article-title":"Once-daily prolonged-release tacrolimus formulations for kidney transplantation: What the nephrologist needs to know","volume":"30","author":"Piotti","year":"2017","journal-title":"J. Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1111\/tri.12798","article-title":"A high intrapatient variability in tacrolimus exposure is associated with poor long-term outcome of kidney transplantation","volume":"29","author":"Shuker","year":"2016","journal-title":"Transpl. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100531","DOI":"10.1016\/j.trre.2020.100531","article-title":"Optimization of tacrolimus in kidney transplantation: New pharmacokinetic perspectives","volume":"34","author":"Oberbauer","year":"2020","journal-title":"Transplant. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"51","DOI":"10.5500\/wjt.v2.i4.51","article-title":"Current state of renal transplant immunosuppression: Present and future","volume":"2","author":"Kalluri","year":"2012","journal-title":"World J. Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Meremo, A., Paget, G., Duarte, R., Dickens, C., Dix-Peek, T., Bintabara, D., and Naicker, S. (2022). Demographic and clinical profile of black patients with chronic kidney disease attending a tertiary hospital in Johannesburg, South Africa. PLoS ONE, 17.","DOI":"10.1101\/2022.03.16.22272477"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Gordon, T., Booysen, F., and Mbonigaba, J. (2020). Socio-economic inequalities in the multiple dimensions of access to healthcare: The case of South Africa. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-8368-7"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.ekir.2019.05.006","article-title":"JC virus and APOL1 risk alleles in black South Africans with hypertension-attributed CKD","volume":"4","author":"Nqebelele","year":"2019","journal-title":"Kidney Int. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"12605","DOI":"10.3389\/ti.2024.12605","article-title":"Impact of Asian and Black Donor and Recipient Ethnicity on the Outcomes After Deceased Donor Kidney Transplantation in the United Kingdom","volume":"37","author":"Hakeem","year":"2024","journal-title":"Transpl. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"gfaa142-P1706","DOI":"10.1093\/ndt\/gfaa142.P1706","article-title":"P1706THE GRAFT SURVIVAL OF KIDNEY TRANSPLANTATION ACCORDING TO ETHNICITY IN KIDNEY TRANSPLANT RECIPIENTS","volume":"35","author":"Jung","year":"2020","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Bekbolsynov, D., Mierzejewska, B., Khuder, S., Ekwenna, O., Rees, M., Green, R.C., and Stepkowski, S.M. (2022). Improving Access to HLA-Matched Kidney Transplants for African American Patients. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.832488"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1038\/tpj.2015.87","article-title":"Genotype-guided tacrolimus dosing in African-American kidney transplant recipients","volume":"17","author":"Sanghavi","year":"2017","journal-title":"Pharmacogenomics J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1097\/TP.0b013e318277438f","article-title":"Outcomes in African American kidney transplant patients receiving tacrolimus and mycophenolic acid immunosuppression","volume":"95","author":"Narayanan","year":"2013","journal-title":"Transplantation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"13022","DOI":"10.3389\/ti.2024.13022","article-title":"Clinical Impacts of Allograft Biopsy in Renal Transplant Recipients 10 Years or Longer After Transplantation","volume":"37","author":"Hamano","year":"2024","journal-title":"Transpl. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1111\/j.1600-6143.2004.00332.x","article-title":"Lack of improvement in renal allograft survival despite a marked decrease in acute rejection rates over the most recent era","volume":"4","author":"Schold","year":"2004","journal-title":"Am. J. Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1111\/j.1365-2125.2011.04039.x","article-title":"Dosing equation for tacrolimus using genetic variants and clinical factors","volume":"72","author":"Passey","year":"2011","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Undre, N., Schafer, A., and European Tacrolimus Multicentre Renal Study Group (1998). Factors affecting the pharmacokinetics of tacrolimus in the first year after renal transplantation. Transplantation Proceedings, Elsevier.","DOI":"10.1016\/S0041-1345(98)00234-6"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1111\/bcp.12703","article-title":"Progressive decline in tacrolimus clearance after renal transplantation is partially explained by decreasing CYP3A4 activity and increasing haematocrit","volume":"80","author":"Vanhove","year":"2015","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"374","DOI":"10.2215\/CJN.03791106","article-title":"Therapeutic monitoring of calcineurin inhibitors for the nephrologist","volume":"2","author":"Schiff","year":"2007","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1038\/ki.2009.377","article-title":"KDIGO clinical practice guideline for the care of kidney transplant recipients: A summary","volume":"77","author":"Kasiske","year":"2010","journal-title":"Kidney Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1097\/FTD.0000000000000640","article-title":"Therapeutic drug monitoring of tacrolimus-personalized therapy: Second consensus report","volume":"41","author":"Brunet","year":"2019","journal-title":"Ther. Drug Monit."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"342","DOI":"10.2174\/1389200219666180101104159","article-title":"Tacrolimus-pharmacokinetic considerations for clinicians","volume":"19","author":"Tholking","year":"2018","journal-title":"Curr. Drug Metab."},{"key":"ref_31","first-page":"492","article-title":"Risk factors for long-term graft loss in kidney transplantation: Experience of a Mexican single-center","volume":"54","author":"Rojas","year":"2002","journal-title":"Rev. Investig. Clin. Organo Hosp. Enfermedades Nutr."}],"container-title":["Pharmaceutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4923\/18\/1\/132\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T11:15:25Z","timestamp":1768994125000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4923\/18\/1\/132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,21]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["pharmaceutics18010132"],"URL":"https:\/\/doi.org\/10.3390\/pharmaceutics18010132","relation":{},"ISSN":["1999-4923"],"issn-type":[{"value":"1999-4923","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,21]]}}}