Pharmacogenomics Aspect of Immunosuppressant Therapy

Pharmacogenetics is the discipline that translates information on genetic variability into prediction of the pharmacokinetics and pharmacodynamics effects of drugs. It was hoped that patients would receive the best drug in the correct dose and experience less adverse events based on their genetics. Currently, for patients receiving a transplant, drug concentration measurements are performed routinely at every outpatient visit and during hospital admission. Target concentrations have been defined depending on the type of organ transplant, the perceived risk of rejection, time post-transplantation, co-medications, and adverse events. However, the evidence that therapeutic drug monitoring does improve outcome is weak at best, and yet the monitoring of drug concentrations is widely accepted. Conversely, pharmacogenetic tests to further individualize drug therapy are currently rarely used, despite reported associations between drug dose requirement and genotype. Evidence that implementation of a pharmacogenetic test will improve clinical outcome is lacking. The future of pharmacogenetics will be in treatment models in which patient characteristics are combined with polymorphisms in multiple genes. Such models will provide more information than the relatively small candidate gene studies performed so far.

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