Gold A, Tönshoff B, Döhler B, et al. - Given an alarmingly increased likelihood of premature kidney graft loss due to immunological rejection in correlation with adolescent and young adult age, researchers here examined if a more intense and less variable exposure to tacrolimus could counteract this young‐age‐related enhanced immunoreactivity. They analyzed data from the large database of the Collaborative Transplant Study and identified a 5‐year graft survival rate of 85.1% among kidney graft recipients aged 12–23 years (n = 964) with a 1‐year tacrolimus trough level between 4.0–10.9 ng/mL, which is significantly better than the poor 66.1% rate in cases with a trough level below 4.0 ng/mL who showed a 2.38‐fold elevated risk of graft loss in the multivariable analysis. This correlation did not appear in young children aged 0–11 years (n = 455) and was less pronounced in adults aged 24–34 years (n = 1,466). However, there was an increased risk of graft loss in both 12–23‐ as well as 0–11‐year‐old recipients in correlation with an intra‐patient variability of tacrolimus (IPV) trough level ≥ 1.5 at posttransplant years 1 and 2. As nearly 30% of kidney graft recipients had high IPV, a more intense and less variable exposure to tacrolimus may aid in improving graft survival strongly in this high‐risk group.