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Genvigir et al. J Transl Genet Genom 2020;4:320-55 I http://dx.doi.org/10.20517/jtgg.2020.37 Page 351

follow-up time, time after transplantation, definition of the analyzed events (for example, AR, DGF or
adverse events), and analytical methods for measurement of the MPA exposure.

Together, these heterogeneities demonstrate the limitations of this review for pointing out the
pharmacogenetic biomarkers useful for clinical applications of MPA in kidney transplantation.

CONCLUSION
Individualized treatment can contribute to improve efficacy and decrease the toxicity of immunosuppressive
drugs. Here, the influence of genetic variants on MPA pharmacokinetics and pharmacodynamics in
kidney transplant recipients was reviewed. The combination of multiple drugs, the different sample
sizes, and the lack of association consistency between studies have been important challenges of
MPA pharmacogenomics. Together they limit the conclusions and clinical applications of MPA
pharmacogenomics in kidney transplantation. Currently, further pharmacogenomic studies are needed to
elucidate the contribution of genetic background to the effectiveness and safety of MPA therapy.

DECLARATIONS
Acknowledgments
Genvigir FDV and Hirata TDC were recipients of a fellowship from FAPESP, Brazil. Hirata MH and Hirata
RDC are recipients of a fellowship from CNPq, Brazil.

Authors’ contributions
Made substantial contributions to the conception and design of the study and performed data analysis and
interpretation: Genvigir FDV, Cerda A, Hirata RDC
Prepared the figure and critically reviewed the manuscript: Hirata TDC, Hirata MH

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

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