Therapeutic drug monitoring (TDM) of immuno-suppressive medications is considered an important tool in the management of patients treated with solid organ transplantation. TDM of calcineurin- and mTOR inhibitors is widely used, while TDM of anti-metabolites and other drugs is less frequent. Uncertainties concerning optimal drug concentrations still exist and individualization of the treatment is difficult. There is no clear relationship between drug concentrations that can be measured at several time points and the effects and interactions of drugs. Furthermore, a large variation is often seen from one measurement to the next and the methods for measurements may differ.

Optimization of TDM can lead to avoidance of therapy with toxic or too low doses leading to rejection of the transplanted organ. The time points to be used should be more clear, and the role of TDM as a tool in minimalization and personalization of the immunosuppressive treatment further developed.

This Research Topic will place an emphasis on analytical problems in the laboratory, pharmacokinetic aspects, and the clinical strengths and pitfalls of TDM in solid organ transplantation. We will also collect and explore knowledge on the cost-effectiveness of TDM in relation to improvements of long term graft function and avoidance of side effects such as infections and cancer.

We invite original manuscripts and reviews contributing with novel or updated information within the field of TDM of immuno-suppressive drugs in solid organ transplantation. Contributors may address themes such as:

• Laboratory and analytical aspects of drug concentration measurements including novel methodologies such as “point of care” testing, different methodologies for calculating exposure
• Determinants of variability in concentrations of immunosuppressive drugs (pharmacokinetic and pharmacogenetic aspects)
• Novel information about TDM and alternative biomarkers of immunosuppression (do blood concentrations of drugs reflect their effects on the immune system)
• The role of TDM to improve graft survival - the background for current guidelines on TDM of tacrolimus, mTOR inhibitors and other drugs
• TDM in the management of adverse effects of immunosuppressive drugs
• TDM in the management of opportunistic infections in organ-transplanted patients
• Personalization of immunosuppressive treatment using TDM including care for special groups such as young and elderly, obese and different ethnic groups
• TDM of novel biological therapies in organ transplantation
• Cost effectiveness of TDM

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Frontiers in Pharmacology

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