Objective Tacrolimus is an immunosuppressive drug with narrow therapeutic range and wide interindividual variation in its pharmacokinetics. Tacrolimus is a substrate of cytochrome P450(CYP)3A5. The aim of this study was to evaluate whether the A6986G polymorphism is associated with tacrolimus concentration/dose ratio.Methods Fifty-two Chinese renal transplant patients were enrolled in this study. Their body weight, dosage and concentration of tacrolimus were observed. CYP3A5 genotype was determined by polymerase chain reaction followed by restriction fragment length polymorphism analysis. Results A significant association was found between tacrolimus levels per dose/kg/d and CYP3A5 gene A6986G polymorphism(P＜0.001). The CYP3A5 * 3 * 3 patients have a significantly higher tacrolimus level/dose than CYP3A5 * 1 * 1 and CYP3A5 * 1 * 3. Conclusions CYP3A5 gene A6986G polymorphism is associated with tacrolimus pharmacokinetics and dose requirements. Pharmacogenetic methods could be employed prospectively to help the dose selection and to individualize immunosuppressive therapy according to the result.