Age and sex determine conversion from immediate-release to extended-release tacrolimus in a multi-center cohort of Canadian pediatric renal transplant recipients

Pediatr Transplant. 2021 Aug;25(5):e13959. doi: 10.1111/petr.13959. Epub 2020 Dec 23.


ER-Tac, taken once per day, is associated with improved adherence. This study examined the potential patient and clinical factors that influence clinicians to convert pediatric patients from immediate-release to ER-Tac. This prospective multi-center observational study followed Canadian pediatric kidney transplant recipients up to 5 years post-transplant. Cox Proportional Hazards Regression was used to examine the influence of factors on conversion to ER-Tac. Sixty-six participants were included in this analysis. For every additional year of age at the time of transplant, the likelihood of conversion was more than doubled (HR 2.54, CI 1.83, 3.54, P < 0.001). The impact of age reduced by three percent for every month after transplant (HR 0.97, CI 0.95, 0.98, P < 0.001). Girls were more likely to be converted than boys (HR 3.78, CI 1.35, 10.6, P 0.01). Adherence measures (MAM-MM and tacrolimus trough variability), individual barriers to adherence, renal function, HLA mismatch, and rejection were not significant predictors of conversion in the final regression model. ER-Tac was preferentially prescribed to older age and female patients. Female sex and adolescence are both associated with worse graft outcomes, but we found no link between individualized markers of adherence/graft risk and conversion. Clinicians appeared to be using demographic features to distinguish patients at perceived higher risk and converted accordingly, without a case-by-case evaluation of who is more susceptible to poor outcomes.

Keywords: age; extended-release tacrolimus; gender; immunosuppression; kidney; medication adherence; pediatric; sex; transplant.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adolescent
  • Adolescent Behavior / psychology
  • Age Factors
  • Canada
  • Child
  • Clinical Decision-Making / methods*
  • Delayed-Action Preparations
  • Female
  • Follow-Up Studies
  • Graft Rejection / prevention & control*
  • Humans
  • Immunosuppressive Agents / administration & dosage*
  • Immunosuppressive Agents / therapeutic use
  • Kidney Transplantation*
  • Male
  • Medication Adherence / psychology
  • Medication Adherence / statistics & numerical data*
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Sex Factors
  • Tacrolimus / administration & dosage*
  • Tacrolimus / therapeutic use


  • Delayed-Action Preparations
  • Immunosuppressive Agents
  • Tacrolimus