*Purpose: The purpose of this study is to evaluate whether a difference in tacrolimus total daily dose (TDD) exists between those receiving a liver transplant from African American (AA) donors compared to non-African American (non-AA) donors 6 to 8 weeks post-transplant.

*Methods: Retrospective chart review of liver transplant recipients at least 18 years old between March 2015 and June 2018 who were initiated on tacrolimus. Patients were excluded if they received a multi-organ transplant or if the donor’s race was unable to be identified. The primary objective is to evaluate whether there is a difference in tacrolimus TDD in liver recipients of AA donors compared to non-AA donors 6 to 8 weeks post-transplant. The center-specific target tacrolimus trough is 6-10 ng/mL through month three post-transplant. Secondary objectives are to evaluate tacrolimus TDD at hospital discharge and 3 months post-transplant respectively, time to tacrolimus trough greater than 6 ng/mL, incidence of biopsy proven rejection, hospital length of stay, incidence of immediate release (IR) tacrolimus discontinuation within 6 months of transplant, and reason for IR tacrolimus discontinuation.

*Results: Of the 295 liver recipients meeting inclusion criteria, 27 liver recipients were identified as having an AA donor and 81 liver recipients of non-AA donors were randomly selected to create a 3:1 comparator arm. The mean age was 59 in the group with AA donors and 56 in the group with non-AA donors with a majority of liver recipients being male (67% vs. 79%) and Caucasian (96% vs. 94%). The mean MELD score was 24 in the AA donor group and 23 in the non-AA donor group. The majority of patients received deceased donor organs (100% AA donor group, 90% non-AA donor group). There was no statistical difference in tacrolimus TDD between AA (7.2 ± 3.2 mg) and non-AA donors (5.5 ± 2.9 mg) at 6 to 8 weeks post-transplant (p=0.06). There was a statistical difference in tacrolimus TDD between AA(7.3 ± 3.4 mg) and non-AA donors (5.7 ± 2.8 mg) at 3 months post-transplant (p=0.03). There was no statistical difference in the rate of graft rejection in liver recipients of AA donors (22%) compared to non-AA donors (11%) (p=0.27).

*Conclusions: This study did not find a statistically significant difference in tacrolimus TDD in liver recipients from African-American donors compared to non-African-American donors 6 to 8 weeks post-transplant. Tacrolimus TDD was found to be higher 3 months post-transplant in liver recipients of African-American donors. We conclude it may be reasonable to have a low threshold to increase tacrolimus dosing in patients who receive a liver transplant from an African American donor.

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