目的 评价他克莫司个体内变异性（IPV）与心脏移植术后感染、排斥及死亡的相关性。 方法 收集 2018 年 4 月至 2021 年 10 月郑州市第七人民医院心脏移植受者术后第 3~6 个月的他克莫司谷 浓度（C0），剂量校正后计算他克莫司 IPV，根据平均值分为高 IPV 组和低 IPV 组，比较两组受者预后 差异。结果 共纳入 102 例受者，IPV 平均值为 26.8%。相对于低 IPV 组，高他克莫司 IPV 组的至少一次 C0在治疗目标（8 ~ 12 ng/mL）范围之外的受者比例更高（< 8 ng/mL：80.5% vs. 39.3%，χ2 = 16.836，P < 0.001； > 12 ng/mL：85.4% vs. 47.5%，χ2 = 15.007，P < 0.001）。高 IPV 组受者的感染发生率高于低 IPV 组（34.2% vs. 16.4%），率差及95%置信区间为17.8%（0.52% ~ 34.99%），差异有统计学意义（χ2 = 4.295，P = 0.038）。排斥反 应和死亡方面，两组组间比较差异无统计学意义（均P > 0.05）。感染、排斥或者死亡其中之一即复合终点， 两组比较具差异有统计学意义（18.03% vs. 39.02%，χ2 = 5.551，P = 0.018）。结论 高他克莫司IPV的心脏移 植受者可能更容易发生感染，他克莫司IPV 简便易得，可作为识别移植术后较差预后的随访工具。

Objective To evaluate the association between tacrolimus intra⁃patient variability（IPV）and infection，rejection and death after heart transplantation. Methods Tacrolimus trough concentration（C0）was collected from heart transplant recipients in Zhengzhou Seventh People′s Hospital from April 2018 to October 2021 at 3 ~ 6 months after surgery. IPV was calculated after dose correction，and patients were divided into the high IPV group and the low IPV group. Results A total of 102 patients were enrolled，with an average IPV of 26.8%. Compared with the low IPV group，the proportion of recipients with at least one C0 outside the treatment target （8 to 12 ng/mL）was higher in the high tacrolimus IPV group（< 8 ng/mL：80.5% vs. 39.3%，χ2 = 16.836，P < 0.001；> 12 ng/mL：85.4% vs. 47.5%，χ2 = 15.007，P < 0.001）. The incidence of infection in the high IPV group was higher than that in the low IPV group（34.2% vs. 16.4%），with a 95% confidence interval of 17.8%（0.52% ~ 34.99%）. The difference was statistically significant（χ2 = 4.295，P = 0.038）. There was a statistically significant difference between the two groups in the combination of infection，rejection or death（18.03% vs. 39.02%，χ2 = 5.551，P = 0.018）. Conclusions The recipients with a high tacrolimus IPV may be more susceptible to infection after heart transplantation. Tacrolimus IPV is readily available and can be used as a follow⁃up tool to identify poor outcomes after transplantation.