Summary: Kidney transplantation is the method of choice to treat end-stage kidney disease. Introduction of the immunosuppressive therapy significantly improved short- and long-term outcomes. Standard immunosuppression includes triple therapy based on calcineurin inhibitor, today is mainly tacrolimus, antiproliferative drug, mainly mycophenolate mofetil and steroids. The major goal is to prevent rejection, however, in the long-term also to avoid other complications such as malignancy, infections and cardiovascular complications. Therefore, we need to find a balance between under- and over immunosuppression. Several factors are taken into account to personalize immunosuppression such as age, gender, pharmacogenetics, including the most commonly studied CYP3A5 genotypes for tacrolimus. Hovewer, we need more data to introduce personalized care for kidney transplant recipients into everyday clinical practice.