Tacrolimus exposure and intra-patient variability in paediatric and young adult kidney transplant recipients: one size does not fit all.

Paediatric practice recommendations on the use of tacrolimus following kidney transplantation are largely based on the experience from adult solid organ recipients. It has been reported that adequate tacrolimus exposure in adults can impact patient outcomes. As shown in the SYMPHONY trial, adult de novo kidney transplant patients with a target tacrolimus pre-dose concentration (TAC C0 ) of 3-7 ng/ml had a higher glomerular filtration rate and a lower incidence of acute rejection one year following transplantation compared to those treated with cyclosporine A or sirolimus.