Solid organ transplantation remains a limited resource despite an increasing number of patients who require this life saving procedure. Understanding the unique intersection between donor and recipient genomes lies at the core of precision medicine in transplantation. Identification of genomic biomarkers that can predict risk of clinically relevant events and allow for tailored intervention is essential to the ongoing success of precision-based transplant medicine. This chapter highlights recent developments including ever more sophisticated data collection and analysis at the molecular level that have advanced the field of solid organ transplantation.