Immune monitoring after pediatric kidney transplantation in addition to classical (pharmacokinetic) monitoring

After kidney transplantation immunosuppressive therapy is necessary to avoid acute and chronic rejections; however, the immunosuppressive medication causes an increased risk of severe viral and bacterial infections and is associated with many undesired drug side effects. For optimization of the immunosuppressive treatment, it is therefore crucial to achieve the optimal individual balance between overimmunosuppression and underimmunosuppression and thereby reduce undesired drug side effects. In the routine use the control of immunosuppressants is performed primarily by monitoring of trough levels in blood that mirror the pharmacokinetics but not pharmacodynamics. Diagnostic and prognostic markers to assess the individual intensity of immunosuppression are missing, which is particularly important in childhood due to the increased risk of infections. In addition to classical trough level monitoring various procedures of immune monitoring for determination of the immune defence and the degree of immunosuppression are currently being evaluated. The aim of immune monitoring in addition to classical trough level monitoring is to personalize the immunosuppressive therapy in the sense of an effect-related drug monitoring.