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2017 ; 4
(ä): 2054358116688227
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English Wikipedia
Changing Paradigms in the Management of Rejection in Kidney Transplantation:
Evolving From Protocol-Based Care to the Era of P4 Medicine
#MMPMID28270929
Maier M
; Takano T
; Sapir-Pichhadze R
Can J Kidney Health Dis
2017[]; 4
(ä): 2054358116688227
PMID28270929
show ga
PURPOSE OF REVIEW: P4 medicine denotes an evolving field of medicine encompassing
predictive, preventive, personalized, and participatory medicine. Using the
example of kidney allograft rejection because of donor-recipient incompatibility
in human leukocyte antigens, this review outlines P4 medicine's relevance to the
various stages of the kidney transplant cycle. SOURCES OF INFORMATION: A search
for English articles was conducted in Medline via OvidSP (up to August 18, 2016)
using a combination of subject headings (MeSH) and free text in titles,
abstracts, and author keywords for the concepts kidney transplantation and P4
medicine. The electronic database search was expanded further on particular
subject headings. FINDINGS: Available histocompatibility methods exemplify
current applications of the predictive and preventive domains of P4 medicine in
kidney transplant recipients' care. Pharmacogenomics are discussed as means to
facilitate personalized immunosuppression regimens and promotion of active
patient participation as a means to improve adherence. LIMITATIONS: For
simplicity, this review focuses on rejection. P4 medicine, however, should more
broadly address health concerns in kidney transplant recipients, including
competing outcomes such as infections, malignancies, and cardiovascular disease.
This review highlights how biomarkers to evaluate these competing outcomes
warrant validation and standardization prior to their incorporation into clinical
practice. IMPLICATIONS: Consideration of all 4 domains of the P4 medicine
framework when caring for and/or studying kidney transplant recipients has the
potential of increasing therapeutic efficiency, minimizing adverse effects,
decreasing health care costs, and maximizing wellness. Technologies to gauge
immune competency, immunosuppression requirements, and early/reversible
immune-mediated injuries are required to optimize kidney transplant care.