A randomized trial in lung transplant recipients found that switching from twice-daily tacrolimus to once-daily extended-release tacrolimus did not reduce tremor severity over two years. The study evaluated both objective and patient-reported tremor measures. For transplant centers and patients, the result directly affects expectations for tolerability improvements from formulation changes. Extended-release dosing can improve convenience and adherence, but tremor outcomes did not shift in this dataset. The trial adds to the body of evidence weighing quality-of-life benefits against clinical performance endpoints when optimizing immunosuppressive regimens.