Precision Immunosuppression in Kidney Transplantation: A Comprehensive Review

Individualized immunosuppression represents a paradigm shift in kidney transplant from traditional "trial-and-error" dosing strategies toward individualized regimens. Precision immunosuppression is informed by pharmacogenetics, biomarkers, therapeutic drug monitoring, and recently artificial intelligence-based prediction models, although stratified risk assessment of patients is still mandatory. This review investigated the current evidence on individualized induction and maintenance immunosuppression. In addition, the roles of pharmacokinetics, pharmacogenomics, and emerging biomarker platforms were reviewed and future pathways for tailored posttransplant care were outlined. In summary, the data indicate that optimized immunosuppressive therapy improves graft outcomes, reduces toxicity, and enables targeted minimization strategies in selected recipients.