Tacrolimus is the mainstay of immunosuppression in renal transplantation (RT). However, it has highly variable bioavailability and a narrow therapeutic range. Its metabolism depends upon CYP3A4 and ABCB1gene polymorphism. There is limited data regarding the influence of this polymorphisms on TAC drug level and complications from India. Methods: This is a prospective study done over a period of 2 years (2016-2018) from NIMS Hyderabad. A total of 152 patients were recruited. Frequency of CYP3AB(A6986>G) & ABCB1 (C1236>T, G2677>T and C3435>T) polymorphisms were detected by PCR followed by Sanger's sequence-based genotype & RFLP. Accordingly patients were divided into wild variant(CYP3A5-AA) where there is full expression of the enzyme, heterozygous(CYP3A5-AG), homozygous group who were non expressors (CYP3A5-GG). Day 3, 30,60,90 tacrolimus concentrations and tacrolimus concentration/drug (C/D) ratio were measured. Tacrolimus related toxicity, infections and rejections and the serum creatinine at the time of discharge were compared among the groups Results: Out of 152 renal transplant recipients, 120(78%) were males. 37 patients received deceased donor grafts.. Immediate graft function was seen in 117(76%). Tacrolimus C/D ratio was less in wild (AA) variety compared to both AG (0.006) and GG (P
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