The Impact of Vonoprazan on Tacrolimus Blood Levels in Transplant Recipients: A Systematic Review and Meta-Analysis
Abstract
Background: Tacrolimus is essential for immunosuppression in transplant recipients but presents risks of toxicity and rejection due to its narrow therapeutic window. Vonoprazan, increasingly replacing proton pump inhibitors (PPIs) in these patients, may alter tacrolimus blood levels, but its impact remains unclear. Objective: To assess how switching from PPIs to vonoprazan affects tacrolimus through concentration and concentration-to-dose ratio, and to summarize related liver and kidney safety markers in transplant recipients. Methods: A systematic review was conducted of four Japanese studies (140 kidney or liver transplant recipients) evaluating tacrolimus-based immunosuppression before and after conversion to vonoprazan. The synthesis used exploratory meta-analyses and narrative interpretation, with clinically meaningful changes prespecified, while emphasizing study limitations. Results: Across studies, a trend toward higher tacrolimus levels was seen after switching to vonoprazan. However, the magnitude and consistency of these changes varied substantially between studies, and most results did not surpass thresholds for clinical concern. Liver and kidney safety signals were generally small and inconsistent. High risk of bias, considerable heterogeneity, and absence of pooled clinical endpoints prevent drawing firm conclusions from quantitative data. Pooled estimates are reported as exploratory only. Conclusions: There is low-certainty evidence that vonoprazan may…
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Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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