# Corrigendum: Hidden in Plain Sight: High Tacrolimus Metabolism Doubles Kidney Transplant Failure and Drives Infection Related Mortality

## TL;DR

High tacrolimus metabolism in kidney transplant patients is linked to higher transplant failure and infection-related deaths, with strategies like diltiazem and steroid tapering potentially improving outcomes.

## Contribution

The study identifies high tacrolimus metabolism as a significant risk factor for transplant failure and infection mortality, using the largest dataset to date.

## Key findings

- 25.2% of kidney transplants had low tacrolimus concentration-dose-ratio (CDR), linked to a 2.80 hazard ratio for poor outcomes.
- Low CDR was associated with a 63% increase in infection-related mortality.
- Strategies like diltiazem co-medication and steroid tapering may improve outcomes in high-risk groups.

## Abstract

High tacrolimus metabolism is linked to increased kidney transplant failure and infection-related mortality. The study analyzed 21,865 kidney transplants from 2000 to 2019, the largest to date. About 25.2% had a low concentration-dose-ratio (CDR), predicting poor outcomes with a hazard ratio up to 2.80 and a 63% increase in infection-related mortality. Higher risk groups include females, young individuals, and those with CYP3A5*1A. Strategies like diltiazem co-medication and steroid tapering may improve long-term outcomes in patients with low CDR. Conducted by Caner Süsal, published in Transplant International.