PDF(Pubmed)
Abstract：
Further improvements of outcome after solid organ transplantation will depend on our ability to integrate personalized medicine in clinical routine. Not only better risk stratification or improved diagnostics, also targeted therapies and predictive markers of treatment success are needed, as there is a virtual standstill in the development and implementation of novel therapies for prevention and treatment of allograft rejection. The integration of clinical decision support algorithms and novel biomarkers in clinical practice will require a different reasoning, embracing concepts of uncertainty and probabilistic thinking as the ground truth is often unknown and the tools imperfect. This is important for communication between healthcare professionals, but patients and their caregivers also need to be informed and educated about the levels of uncertainty inherent to personalized medicine. In the translation of research findings and personalized medicine to routine clinical care, it remains crucial to maintain global consensus on major aspects of clinical routine, to avoid further divergence between centres and countries in the standard of care. Such consensus can only be reached when experts with divergent opinions are willing to transcend their own convictions, understand that there is not one single truth, and thus are able to embrace a level of uncertainty.
摘要：
实体器官移植后结果的进一步改善将取决于我们将个性化医疗整合到临床常规中的能力。不仅更好的风险分层或改进的诊断，还需要靶向治疗和治疗成功的预测标志物，因为在开发和实施用于预防和治疗同种异体移植物排斥的新疗法方面存在几乎停滞。临床决策支持算法和新型生物标志物在临床实践中的整合将需要不同的推理。拥抱不确定性和概率思维的概念，因为地面真理往往是未知的，工具也是不完善的。这对于医疗保健专业人员之间的沟通很重要，但患者及其护理人员也需要了解个性化医疗固有的不确定性水平。在将研究成果和个性化医疗转化为常规临床护理时，在临床常规的主要方面保持全球共识仍然至关重要，以避免中心和国家之间在护理标准上的进一步差异。只有意见分歧的专家愿意超越自己的信念,才能达成这样的共识,明白没有一个单一的真理，因此能够接受一定程度的不确定性。
