High tacrolimus intrapatient variability is associated with graft loss after kidney transplantation: a systematic review and meta-analysis

High tacrolimus intrapatient variability is associated with graft loss after kidney transplantation: a systematic review and meta-analysis. Download PDF Abstract Tacrolimus intrapatient variability (IPV) has been proposed as a predictor of adverse outcomes after kidney transplantation, but the magnitude and consistency of this association across IPV measurement methods remain unclear. We conducted a systematic review and meta-analysis of cohort studies evaluating the association between tacrolimus IPV and clinical outcomes in adult kidney transplant recipients.

MEDLINE, CENTRAL, Scopus, and Embase were searched from inception through October 2025. The primary outcome was death-censored graft loss (DCGL). Random-effects meta-analyses used a three-level model to account for dependence among multiple effect sizes within studies.

Ten studies involving 11,647 patients were included. High tacrolimus IPV was associated with increased risk of DCGL (HR 2.13, 95% CI 1.37–3.32; I2 = 69.3%) and rejection (HR 2.05, 95% CI 1.24–3.41; I2 = 0.0%). Point estimates were similar across IPV calculation methods, geographic regions, and assessment timeframes, although subgroup analyses were exploratory and imprecise.

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