Pharmacogenetics in solid organ transplantation: current status and future directions

Tailoring of immunosuppressive drug therapy to the specific requirements of the individual patient to optimize efficacy and minimize toxicity remains one of the biggest challenges in solid organ transplantation. Pharmacogenetic and pharmacogenomic research, studying the effects of genetic polymorphisms on drug disposition and action, holds promise to produce useful clinical tools for individualizing immunosuppressive therapy. In the past years, many interesting studies have been reported, assessing the impact of single nucleotide polymorphisms of genes encoding drug metabolizing enzymes, drug transporters and—to lesser extent—pharmacological target molecules, on pharmacokinetics and pharmacodynamics of immunosuppressive drugs like tacrolimus, cyclosporine, sirolimus, mycophenolic acid, and corticosteroids. Currently, we still are in the early phases of this exciting research, and the question whether pharmacogenetic profiling will eventually become a useful clinical tool remains to be answered.