What is known about this subject?

• Lung transplant recipients often develop acute kidney injury evolving into chronic kidney disease increasing both morbidity and mortality.

• To date, the pathophysiology of kidney injury after lung transplantation has not been fully elucidated.

• The immunosuppressant tacrolimus is difficult to dose, especially in the unstable clinical setting, and is nephrotoxic.

What this study adds:

• For the first time, supra-therapeutic whole-blood tacrolimus trough concentrations are related to the emergence of acute kidney injury in the first days after lung transplantation.

• Supra-therapeutic whole-blood tacrolimus trough concentrations often occur early after lung transplantation.

• AKI after lung transplantation shows low recovery rates.