*Purpose: Vascularized composite allotransplantation (VCA) is a life-enhancing (as opposed to life-saving) procedure. Therefore, minimizing adverse outcomes associated with chronic immunosuppression is vital to determining VCA’s risk/benefit ratio. We use an immunosuppression minimization protocol in which tacrolimus is the single drug; however, tacrolimus has a well-known potential for nephrotoxicity. Here we present data on 5 patients whom we switched from tacrolimus immediate-release (PROGRAF) to tacrolimus extended-release (ENVARSUS XR) with the intention of preserving these patients’ kidney health.

*Methods: We performed a retrospective review of serum creatinine levels from 4 hand (Patients 1-4) and 1 penis transplant (Patient 5) recipient, whom we switched from tacrolimus immediate-release (PROGRAF) to tacrolimus extended-release (ENVARSUS XR) with the intention of preserving these patients’ kidney health. Serum creatinine levels were assessed starting 3-months post-transplant or when the patient first came under our care.

*Results: Patients were transitioned to ENVARSUS XR at 7.5 (Patient 1), 5.5 (Patient 2), 2.9 (Patient 3), 0.25 (Patient 4), and 0.8 (Patient 5) years post-transplant. Patient 1 continued to demonstrate a rise in serum creatinine and progressive renal failure. Patients 2, 3, and 5 demonstrated less between-test serum creatinine variability than when on PROGRAF. Patient 4 was transitioned to ENVARSUS XR 3 months post-transplant and has no stabile pre-ENVARSUS XR data to compare; however, this patient showed similarly stabile between-test serum creatinine levels.

*Conclusions: Transitioning patients to extended release immunosuppression can stabilize serum creatinine levels and reduce the risk of nephrotoxicity with the potential added benefit of improved medication compliance. This is important for any transplant and particularly for those whose primary goal is improved quality of life.

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