Changing Paradigms in the Management of Rejection in Kidney Transplantation
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...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2017-01-01
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| Series: | Canadian Journal of Kidney Health and Disease |
| Online Access: | https://doi.org/10.1177/2054358116688227 |
| _version_ | 1818047296006258688 |
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| author | Mirela Maier Tomoko Takano Ruth Sapir-Pichhadze |
| author_facet | Mirela Maier Tomoko Takano Ruth Sapir-Pichhadze |
| author_sort | Mirela Maier |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-10T10:03:32Z |
| format | Article |
| id | doaj.art-c18003d4d3e64970820cf33470993526 |
| institution | Directory Open Access Journal |
| issn | 2054-3581 |
| language | English |
| last_indexed | 2024-12-10T10:03:32Z |
| publishDate | 2017-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Canadian Journal of Kidney Health and Disease |
| spelling | doaj.art-c18003d4d3e64970820cf334709935262022-12-22T01:53:17ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812017-01-01410.1177/2054358116688227Changing Paradigms in the Management of Rejection in Kidney TransplantationMirela Maier0Tomoko Takano1Ruth Sapir-Pichhadze2Metabolic Disorders and Complications, Research Institute of McGill University Health Centre, Montreal, Quebec, CanadaMetabolic Disorders and Complications, Research Institute of McGill University Health Centre, Montreal, Quebec, CanadaCentre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, Quebec, CanadaPurpose 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.https://doi.org/10.1177/2054358116688227 |
| spellingShingle | Mirela Maier Tomoko Takano Ruth Sapir-Pichhadze Changing Paradigms in the Management of Rejection in Kidney Transplantation Canadian Journal of Kidney Health and Disease |
| title | Changing Paradigms in the Management of Rejection in Kidney Transplantation |
| title_full | Changing Paradigms in the Management of Rejection in Kidney Transplantation |
| title_fullStr | Changing Paradigms in the Management of Rejection in Kidney Transplantation |
| title_full_unstemmed | Changing Paradigms in the Management of Rejection in Kidney Transplantation |
| title_short | Changing Paradigms in the Management of Rejection in Kidney Transplantation |
| title_sort | changing paradigms in the management of rejection in kidney transplantation |
| url | https://doi.org/10.1177/2054358116688227 |
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