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Tacrolimus Intra-Patient Variability — ESENeph MCQ

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HardTransplantationTacrolimus Intra-Patient VariabilityESENeph

A kidney transplant recipient on Tacrolimus has significant intra-patient variability (IPV) in Tacrolimus trough levels – levels fluctuate between 3 and 14 ng/mL despite consistent dosing. What is the clinical significance of high IPV?

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Correct answer: E — High IPV is independently associated with increased risk of rejection, graft loss, and de novo donor-specific antibody development

Tacrolimus intra-patient variability (IPV, measured as coefficient of variation of trough levels) is an emerging independent risk factor for poor transplant outcomes. High IPV (CV >30%) is associated with chronic rejection, de novo DSA development, and reduced graft survival. Causes include non-adherence (the most common), drug interactions, variable absorption, diarrhoea, and formulation switching. Management includes adherence assessment, addressing GI issues, and considering extended-release Tacrolimus formulations (which may reduce IPV).

Reference: Shuker et al 2016 – Tacrolimus IPV; Sapir-Pichhadze et al 2014