Why do we need biomarkers in solid organ transplantation

Abstract

Immunosuppressive therapy is administered to all solid organ transplant recipients to help prevent acute rejection and the loss of allograft function. Adequate immunosuppression is a delicate balance between rejection rates and chronic allograft dysfunction on the one hand and immunological and nonimmunological side effects on the other hand. The general strategy is to minimize the toxicity associated with triple immunosuppressive regimens and possibly enhance long-term allograft survival without compromising short-term allograft survival. There are no criteria that enable the clinician to predict who will do well with the decrease or complete avoidance of immunosuppression. It becomes more and more clear that randomized controlled trials will not be able to solve the problem of defining the optimal immunosuppression for a given individual. The most promising road to achieve this goal and to improve chronic allograft survival may be personalized immunosuppression guided by biomarkers complementary to conventional drug monitoring strategies.