Crossover Study to Compare PK of Once Daily LCP-Tacro Tablets to Generic Tacrolimus Capsules Twice Daily.

This is open label, prospective, single-center, randomized, two sequence, three period
crossover study to compare the steady state pharmacokinetics of once daily dosing of
LCP-Tacro tablets to tacrolimus capsules administered twice daily in stable African American
kidney transplant patients.

Approximately 72 male and female African American renal transplant patients on table
immunosuppression regimens will be randomly assigned in a 1:1 ratio to one of two sequences:

Sequence 1: (n=36) 18 patients requiring less than 0.15 mg/kg/day and 18 patients requiring
equal to or greater than 0.15 mg/kg/day. Patients will continue on generic tacrolimus
capsules on days 1-7 (24 hours PK profile on day 7) then patients are switched to LCP-Tacro
tablets (at 15% lower dose of twice daily generic tacrolimus) on day 8.

Sequence 2: (n=36) 18 patients requiring less than 0.15 mg/kg/day and 18 patients requiring
equal to or greater than 0.15 mg/kg/day. Patients will receive LCP-Tacro tablets (at 15%
lower dose than generic tacrolimus twice daily formulation) on days 1-7 (24 hour PK profile
on day 7) patients are switched back to twice daily generic tacrolimus treatment beginning on
day 8.

Inclusion criteria:

- Age ≥18-80 old, male or female

- African Americans

- Willing to give written informed consent and to comply with study visits and
restrictions, including being able to speak, write and understand English

- Pt who have received a primary or secondary transplant

- Pt least 6 (six) mth post-transplant and on a stable dose of tacrolimus

- BMI ≥19

- Pt who are sero-positive for Hepatitis B or C positive may also be enrolled

- Pt maintained on concurrent immunosuppression with stable doses during screening

- Pt on a proton PPI remain on the same PPI formulation and dose during the PK portion
of the study.

- During PK phase Only: Pt taking any medication that could interfere with tacrolimus
blood levels, including prescription and over-the-counter medications, herbal or food
supplements (including grapefruit, and pomegranate products), or medications must
continue the same dose and are willing to continue the same dose/routine

- During PK phase Only: the patient is not scheduled to begin any new medication that
could interfere with tacrolimus blood levels, including prescription and
over-the-counter medications, herbal or food

Exclusion Criteria:

- Evidence of acute rejection episode within the past three months

- Pt not Africa-American

- Recipients of organ transplants other than kidney

- Known to be HIV positive at transplant

- Pt with recurrent focal segmental glomerulosclerosis (FSGS)

- Pt with any severe medical condition (including infection) requiring acute or chronic
treatment

- Pt with a positive DSA

- Pt with a positive BK virus results

- GFR < 25 ml/min measured by MDRD4 as SOC within last 30 days

- Patients with AST, ALT, total bilirubin > 2.5 x ULN or evidence of severe liver
disease

- Pt with WBC < to 2000/mm3 or ANC < to 1500 mm3 with PLT < 75,000/mm3 or HGB < 8 g/dl

- Pt with mental or physical conditions or known non-adherence

- Presence of intractable immunosuppressant complications of side effects resulting in
dose adjustment of tacrolimus

- Exposed to investigational therapy within 30 days prior to enrollment

- No anticipated changes in the immunosuppressive regimen, other than those specified by
the study protocol

- Pt with severe diabetic gastroparesis or other severe GI disturbances

- Pt who have underwent gastric banding or gastric bypass at any time pre or
post-transplant

- Pregnant or nursing (lactating) women, or planning to become pregnant

- Women of child-bearing potential, defined as all women physiologically capable of
becoming pregnant who are unwilling to use a defined SOC of method