Pharmacodynamics monitoring after lung transplantation

Defining the optimal dosage of immunosuppressive drugs remains a significant challenge for solid organ transplant recipients, particularly for lung transplant recipients, who face an increased risk of infection. In these patients, it is crucial to carefully balance immunosuppression to ensure efficacy, prevent rejection, and minimize toxicity. Although the limitations of therapeutic drug monitoring have been widely discussed, pharmacodynamics monitoring has not reached the clinical practice. This review aims to evaluate the various methodologies available for monitoring the effects of immunosuppression in individual patients. While the initial focus was on directly assessing the impact of immunosuppressive treatments, we found limited evidence in this area. Instead, much of the available research is focused on predicting specific outcomes and indirectly assessing immunosuppression needs in lung transplant recipients. In this review, we provide an overview of the different methodologies that can be utilized to enhance the personalization of immunosuppressive therapy following lung transplantation. These include enzymatic monitoring, T-cell mediated functional assays, monitoring of lymphocyte subsets, gene expression profiling, and viral load measurements. Each of these approaches may contribute to a more tailored and effective immunosuppressive strategy for lung transplant recipients.