*Purpose: Potential benefits of once-daily tacrolimus include improved adherence to immunosuppressives and decreased Intrapatient variability (IPV) post kidney transplantation. A retrospective analysis was performed to investigate the impact of concentrations on conversion from twice‑daily to once‑daily tacrolimus in stable kidney graft recipients.

*Methods: A total of 231 patients underwent tacrolimus conversion from January 2018 to August 2019 in our center, and were followed up for 3 months before and after conversion. The patients were divided into high concentration group (≥6ng/ml) and low concentration group (<6ng/ml) according to the stable concentration of FK506 before conversion and the clinical data and characteristics of the two groups were compared.

*Results: The average conversion time of low concentration group was longer than that of high concentration group: 2.4(1.4-2.9) vs 1.2(0.5-2.4) P‹0.001; the conversion rate was higher (1±0.1 vs 0.97±0.14, p=0.0058). IPV after conversion in high concentration group decreased significantly by 6.8(4.1-10.6) vs 4.7(2.7-6.7) , P‹0.001; however, there was no significant decrease in low concentration group by 4.8(2.4-9.1) vs 4.9(2.3-7.7) , p=0.3514. There was no difference in the rejection rate between two groups after conversion, but the infectious complications were significantly reduced, especially in the low concentration group (8.39% vs 3.22% , p=0.030; 15.79% vs 2.63% , P‹0.010) . Graft function were stable (Cr and eGFR) and FBG and serum potassium had no significant effect after conversion.

*Conclusions: Tacrolimus conversion in patients with stable renal function is not affected by pre-conversion concentration, and can reduce the occurrence of infection complications.

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