{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T07:03:02Z","timestamp":1784790182186,"version":"3.55.0"},"reference-count":38,"publisher":"Maad Rayan Publishing Company","issue":"2","content-domain":{"domain":["journalaim.com"],"crossmark-restriction":false},"short-container-title":["Arch Iran Med"],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:p>Introduction: Medication adherence is a crucial factor in liver transplant patients\u2019 improvement of quality of life and survival rates and reduction of allograft rejection. Tacrolimus plays a pivotal role in post-transplant immunosuppressive therapy, which is available both as twice-daily immediate-release tacrolimus (Prograf\u00ae) and once-daily extended-release tacrolimus (Advagraf\u00ae). This study compared adherence, adverse effects, and clinical outcomes between patients using once-daily extended-release tacrolimus (ERT; Advagraf\u00ae) and twice-daily immediate-release tacrolimus (IRT; Prograf\u00ae) in a real-world setting. Methods: This prospective observational study involved eligible adult liver transplant recipients at least six months post-transplant, prescribed either Prograf\u00ae or Advagraf\u00ae as part of their immunosuppressive regimen. The primary outcome was the change in adherence from baseline to six months. Patient adherence was assessed using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS) at baseline and 6 months. The dose-to-concentration ratio of tacrolimus, potential side effects, and intra-patient variability were assessed at baseline and at one-month and six-month follow-ups. Data were collected through face-to-face interviews, medical records review, pharmacy database exploration, and phone surveys. Results: Baseline adherence was similar between the groups (Prograf\u00ae 48.5% vs. Advagraf\u00ae 41.2%, P=0.39). At six months, the ERT (Advagraf\u00ae) group was associated with higher adherence rates in adjusted analysis (Adjusted Odds Ratio [AOR]: 2.5, 95% CI: 1.1-5.8). Factors significantly associated with higher adherence included older age (AOR: 1.05 per year, 95% CI: 1.01-1.09) and shorter time since transplant (AOR: 0.98 per month, 95% CI: 0.97-0.99). The ERT group also reported a lower incidence of hand tremors (15% vs. 32%, P=0.015). Trough levels, dose\/concentration ratios, and renal function were comparable. Conclusion: In this observational study, the once-daily Advagraf\u00ae formulation was associated with significantly better medication adherence and a lower reported incidence of tremors compared to twice-daily Prograf\u00ae. These findings should be interpreted in the context of the study\u2019s non-randomized design and potential confounding.<\/jats:p>","DOI":"10.34172\/aim.34896","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T06:04:47Z","timestamp":1784786687000},"page":"77-85","update-policy":"https:\/\/doi.org\/10.34172\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison in Patients\u2019 Adherence, Adverse Effects, and Clinical Outcomes Among Liver Transplant Recipients Using Immediate-Release Tacrolimus (Prograf\n                    <sup>\u00ae<\/sup>\n                    ) Versus Extended-Release Tacrolimus (Advagraf\n                    <sup>\u00ae<\/sup>\n                    ): First Report from Iran"],"prefix":"10.34172","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8661-1838","authenticated-orcid":true,"given":"Mojtaba","family":"Shafiekhani","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad Mahdi","family":"Mahmoudi","sequence":"additional","affiliation":[{"name":"Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan","family":"Rostami","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alireza","family":"Shamsaeefar","sequence":"additional","affiliation":[{"name":"Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar","family":"Sohrabi Nazari","sequence":"additional","affiliation":[{"name":"Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marziyeh","family":"Doostfatemeh","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Alishavandi","sequence":"additional","affiliation":[{"name":"Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad Sadegh","family":"Rajabian","sequence":"additional","affiliation":[{"name":"Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0708-334X","authenticated-orcid":true,"given":"Hamed","family":"Nikoupour","sequence":"additional","affiliation":[{"name":"Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"20123","published-online":{"date-parts":[[2026,2,1]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD005161.pub2"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1002\/cld.680"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000296"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.31486\/toj.18.0011"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0160421"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(94)91766-3"},{"key":"R7","unstructured":"Safarini OA, Keshavamurthy C, Patel P. 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