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However, this success has not been translated into long\u2010term benefits by the same magnitude. Optimization of immunosuppression is important to improve the clinical outcome of transplant recipients. It is important to note that each patient has unique attributes and immunosuppression management should not be a one\u2010size\u2010fits\u2010all approach. Elderly transplant patients are less likely to develop acute rejection but more likely to die from infectious and cardiovascular causes than younger patients. For those with post\u2010transplant cancers and BK polyomavirus\u2010associated nephropathy, reduction of immunosuppression can increase the risk of rejection. Therapeutic drug monitoring (TDM) is routinely used for dosage adjustment of several immunosuppressive drugs. It has been hoped that pharmacogenetics can be used to complement TDM in optimizing drug exposure. Among the various drug\u2010genotype pairs being investigated, tacrolimus and CYP3A5 gives the most promising results. Different studies have consistently shown that CYP3A5 expressers require a higher tacrolimus dose and take longer time to achieve target blood tacrolimus levels than nonexpressers. However, for pharmacogenetics to be widely used clinically, further trials are necessary to demonstrate the clinical benefits of genotype\u2010guided dosing such as reduction of rejection and drug\u2010related toxicities. The development of different biomarkers in recent years may help to achieve true personalized therapy in transplant patients.<\/jats:p>","DOI":"10.1111\/nep.14035","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T09:37:52Z","timestamp":1646300272000},"page":"475-483","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Personalized immunosuppression after kidney transplantation"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9940-2568","authenticated-orcid":false,"given":"Chi Yuen","family":"Cheung","sequence":"first","affiliation":[{"name":"Renal Unit, Department of Medicine Queen Elizabeth Hospital  Yau Ma Tei Hong Kong SAR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6862-1941","authenticated-orcid":false,"given":"Sydney Chi 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