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Tacrolimus levels???

Hi everyone. I'm 4 years post transplant and my tacrolimus level with creatinine still hasn't stabilized. This is my second transplant. My creatinine used to be less than 1 but now it's around 1.7. It usually increases with increase in tac dose. My tac level fluctuates so much from being 3.5 to 8. Doctors want it to be around 7 or 8. What are your tacrolimus levels and preferred tac level at your clinics? How long have you had your transplant and your tac peak level? Mine is 16.8. Thank you!

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  • I had similar problem. My tac level once came down to 4 post one and half month tx from 7.9.  Doc immediately increased dosage of pangraf from 3 mg to 4 mg.  As a result,  my creatinine level gradually increased from 0.9 to 1.5 in two months. Then doc decreased the dossage as it is normally done after 3 months tx.  Creatinine level then stepped down to 1.4. Doctor then changed pangraf to certican (everolimus). Consequently,  creatinine level stepped down further to 1.3 for last almost 2 yr. 

    You may explore taking 2nd opinion. Higher dossage of tacrolimus may affect kidney. 

  • Thanks everyone for your answers. It really helps me to see the wide ranges of tac levels with creatinine giving me a peace of mind. I thought I was the only one fluctuating so much that it scared me. So far my doctors haven't said anything after my last visit. I see many different doctors and they all have their own ways of trying to help. I get confused at times. I have my primary transplant doctor and then I have a group of doctors working at a university where I got my surgery done. My primary doctor doesn't mine my tac level going as low as 4 but my other group of doctors want it around 8 for the longevity of my kidney function.
  • I'm the newbie on the block- recent kidney recipient (12-days) so this may or may not be helpful to you.. My ideal tacrolimus level according to my coordinator is between 5-7. I have been sitting between 4 andd 5, and sounds like they want me to be closer to 6. Just made a slight increase to my tac.

    • Oh that's wonderful. Enjoy your kidney! The first 4 years of my transplant, my doctors went up and down on my doses so often. It's gotten a little better now. I had 2 in the morning and 1.5 at night! I had gone up to 4 and 3 before.
  • Hi, I'm post Kidney transplant 3 1/2 years and my Doctors at HUP wanted my tac levels after 12 months post transplant to be between 4- 6 and mine is at 4.4 and goes to 5, they are very happy with my levels. My tac levels have were being decreased with the length of time post transplant. I believe this is the level they are going to want me to stay in. I do always take my meds exactly 12 hours apart and always have my blood drawn with in 15-30 minutes before my next dose. This gives the doctors an exact level of my tac. I was told that by being vigilant in taking my meds on time will help keep my levels stable. One time my level did go up to a 9 but I found out that it was due to me eating pomegranates and since then it has been off my diet list and I have not had any problems. You do have to realize that we are not all going to have the same numbers for we each have different issues and donors and need to just follow out transplant doctors orders.

    I hope this helped and good luck

    Olga

    • Thank you Olga. It's all very interesting. Very helpful! Having two different institutions to see my kidney transplant is hard. But my primary doctor told me recently that we need to give deference to my doctors who saw me through with the surgery so levels need to be around 7 or 8. :)
  • Hi Debs,

    Tacrolimus(FK) and Creatinine levels are two separate measures and are not exclusive to each other.  While higher Tacrolimus levels can elevate Creatinine, this level is also affected by hydration, medications, exertion, illness and so forth.  The "perfect" level for you is just that....perfect for you!  Some Tx centers want a level between 6 and 8.  Other members here have levels much lower.

    My target level is around 7 and my high was an overwhelming 13 at one time.  I was barely able to breathe at that level.  My Creatinine with my first Tx was 1.4, settling at 1.6, two months after the Tx.  My second Tx it was 1.3 in the days after, now it is steady at 1.5.  Fluctuations are common and most patient's CR is somewhat higher after a few months.  Perhaps avoiding foods that block absorption or missing doses is the culprit.  Forcing fluids in the week before blood draws may help.

    A good rule to live by is if your Tx team is not worried, neither should you.  I hope you can be comfortable with your levels and stay well.

    • Thank you! I like your last comment. So true. Remember the time with the biopsy I had? It's been the same battle since then. Increase increase decrease increase. One time it seemed like one of my doctors didn't know what to do. But thank God everything is turning out well!!!
  • This is one of the major concern in my case as well, tac level n CREATNINE has yet not stabilised, Can't say much on this really fed up of this!
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