Individualized immunosuppression: new strategies from pharmacokinetics, pharmacodynamics and pharmacogenomics.
BACKGROUND
The ultimate goal of transplantation is the donor-specific immune tolerance, but at least in the first 15 to 20 years of this century, immunosuppressive agents are still the determinant of clinical outcome of transplant recipients. Individualizing patient's immunosuppression to optimize the balance between therapeutic efficacy and the occurrence of adverse events poses a great challenge to physicians.


METHODS
The data in this article were taken mostly from MEDLINE (2000-2004), part of which were from the research of the authors.


RESULTS
Individualized immunosuppression remains a problem because of the narrow therapeutic index and wide inter- and intra-patient variation of commonly used immunosuppressants. Recent progress in study of pharmacokinetics and pharmacodynamics improved the clinical outcome of transplant recipients. More importantly, the emergence of pharmacogenomics might provide a promising and complementary tool for traditional therapeutic drug monitoring (TDM).


CONCLUSIONS
Individualizing organ recipient's immunosuppression to balance the therapeutic efficacy and the adverse events represents a great challenge to transplant clinicians. Pharmacogenomics shows great promise for an interesting and hopefully better future.
Chen
Geng
G
Army Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China. jhdong@hbsky.org
Dong
Jia-Hong
JH
D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods* / Q000639:trends*; D007166:Immunosuppressive Agents / Q000493:pharmacokinetics / Q000494:pharmacology; D010597:Pharmacogenetics
D007166:Immunosuppressive Agents