Commentary: The Clinical Impact of the C0/D Ratio and the CYP3A5 Genotype on Outcome in Tacrolimus Treated Kidney Transplant Recipients

Van Gelder et al. nicely reviewed about the influence of the C0/D ratio and the CYP3A5 genotype on the outcome of kidney transplant (KTx) recipients treated with tacrolimus (Tac) (van Gelder et al., 2020). The authors report that our group has shown that fast Tac metabolism (C0/D ratio <1.05 ng/ ml/mg) is associated with a faster decline in renal function, a higher incidence of calcineurin inhibitor nephrotoxicity (CNIT) and BK nephropathy and a lower survival rate (Tholking et al., 2014; Tholking et al., 2016; Schutte-Nutgen et al., 2019; Tholking et al., 2019). They comment that there is no evidence that switching from Tac to a mammalian target of rapamycin inhibitor (mTORi) or other substances improves long-term outcome.