Development and Validation of a Nomogram for Predicting Subtherapeutic Tacrolimus Blood Levels in Renal Transplant Recipients: A Multivariate Logistic Regression Analysis

Abstract

This study constructs a nomogram risk prediction model to identify factors affecting subtherapeutic tacrolimus (FK506) blood concentrations in postrenal transplant patients, enhancing clinical management. Data from renal transplant patients treated with tacrolimus from January to December 2023 were analyzed using multivariate logistic regression to identify risk factors. A nomogram model was constructed and validated through cross-validation and bootstrapping. Predictive performance was assessed via receiver operating characteristic curve and Hosmer– Lemeshow test. Among 340 patients, 224 achieved target FK506 concentrations (5-15 ng/mL). Independent risk factors for subtherapeutic levels included white blood cell count ≤4 × 10^9/L, total bilirubin >20 μmol/L, creatinine >73 μmol/L, and blood urea nitrogen ≤7.1 mmol/L. The model's receiver operating characteristic area under the curve was 0.84, with a Hosmer– Lemeshow test P-value of .386, indicating high predictive accuracy and good calibration. The nomogram effectively predicts subtherapeutic FK506 levels, providing a valuable tool for personalized patient management. Future research should refine and externally validate the model.