"One size fits all": immunosuppression in cardiac transplantation

Approximately 20 years have passed since the introduction of cyclosporine-based triple therapy for heart transplant recipients. The major thrust of research has been the "middle-drug" between cyclosporine and steroids, and recent efforts have been directed towards newer antibody preparations to induce rapid immunosuppression post-transplant. However, little effort has been paid to attempts to reduce and tailor immunosuppression to specific patients. This paper describes previous work on the individualized dosing of tacrolimus, including patients who are maintained on monotherapy after heart transplantation with tacrolimus alone. The authors conclude that future efforts need to be directed towards individualizing immunosuppression rather than adopting "one-size-fits-all" institutional protocols.