Optimal Tacrolimus Blood Levels for Transplant Patients

Target Tacrolimus Blood Levels

• The American Association for the Study of Liver Diseases recommends that liver transplant patients maintain tacrolimus trough levels at 6-10 ng/ml during the first month after transplantation, followed by 4-8 ng/ml thereafter 1
• The American Society of Transplantation suggests that kidney transplant patients follow similar target ranges of 6-10 ng/ml during the first month and 4-8 ng/ml after the first month 2
• The International Society for Heart and Lung Transplantation recommends target trough levels of 5-15 ng/ml for lung transplant patients 3, 4
• The European Respiratory Society considers the therapeutic range to be 5-15 ng/ml for adult lung transplant patients once steady state has been attained 5

Monitoring Recommendations

• The American Thoracic Society recommends daily monitoring of tacrolimus levels until target levels are reached in the immediate post-transplant period, followed by every 2-3 days until hospital discharge, and then every 1-2 weeks for the first 1-2 months 3, 4
• The National Kidney Foundation suggests that stable patients can be monitored every 1-2 months once stable levels are attained 3, 4
• More frequent monitoring is required when medications affecting CYP3A4 metabolism are added or withdrawn, or when patients are admitted to hospital with post-transplant complications 3, 4

Special Considerations

• The American Association for the Study of Liver Diseases recommends considering basiliximab induction with delayed introduction of tacrolimus for patients at risk of post-transplant renal dysfunction, and reducing tacrolimus target concentrations in patients who develop renal dysfunction while on therapy 1
• The American Society of Transplantation suggests combining tacrolimus with other immunosuppressive agents (MMF, AZA, or mTORi) to allow for lower tacrolimus trough levels while maintaining efficacy 1, 2
• The American Journal of Transplantation recommends close monitoring when adding or removing medications that inhibit or induce CYP3A4, as tacrolimus is metabolized through this system 3, 4