*Purpose: A previous publication found that fast metabolisers of tacrolimus had inferior renal function compared to slow metabolisers in a Caucasian population (Thölking et al., 2014); the purpose of this study was to assess if this could be replicated in an ethnically diverse renal transplant population.

*Methods: We performed a retrospective observational analysis of 295 participants from previous genotyping studies who underwent renal transplantation between 1995 and 2017. Patients were assigned a tacrolimus metabolism rate as defined by the mean of their trough blood tacrolimus concentrations normalised by their tacrolimus doses (C/D ratios) at day 7, day 14 and 3 months post-transplantation. Participants were stratified into slow, intermediate or fast metaboliser groups (mean C/D ratio of ≥1.55, 1.05-1.54 or <1.05 respectively). Glomerular filtration rate was estimated using the CKD-EPI equation (eGFR). Groups were compared by the Kruskal-Wallis H test.

*Results:

Table 1. Participant numbers by ethnicity and metaboliser group.

Table 2. Mean eGFR (ml/min/1.73m²) by metaboliser group at day 7, day 14 and 3 months after renal transplantation.

*Conclusions: Tacrolimus metabolism rate did not influence renal function after renal transplantation at any time point (Table 2). This is in contrast to previously published data which came from a Caucasian population. Given the ethic heterogeneity in our population (Table 1), we analysed our Caucasian data separately (n=194) but remained unable to demonstrate an impact. These data do not support tacrolimus metabolism rate, defined as mean C/D ratio, as a suitable risk factor for predicting tacrolimus nephrotoxicity.

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