The use of immunosuppressive agents in the treatment of transplant rejection and autoimmune disorders is gaining momentum, with significant improvements of both graft and patient survival. The individual response to drugs, however, is variable and unexpected toxicity, or impaired activity might be seen, as a result of molecular determinants that eventually dictate how the individual will respond to immunosuppressive agents. This review addresses a number of issues related to pharmacogenetics, and discusses how this approach might be used to improve the clinical efficacy and tolerability of therapeutic options for the management of organ transplantation and autoimmune disorders in the next decade.

Gastrointestinal (GI) involvement is not rarely encountered in Churg-Strauss syndrome (CSS). We describe the case of a young white woman presenting with acute acalculous cholecystitis, who subsequently developed, despite prompt administration of immunosuppressive therapy, life threatening GI involvement, requiring multiple operations. Over a 7-month period the patient eventually recovered from her disease. Forty-two months later she is free from symptoms, with low daily doses (6 mg) of oral methylprednisolone. Although medical and surgical complications of CSS may develop while the patient is undergoing therapy, early diagnosis with joint surgical and medical management is essential to bring the disease under control.