Abstract:
This thesis presents three independent essays for the fulfillment of doctoral dissertation in Public Policy. The common theme in these essays is the practice of personalized medicine for kidney transplant recipients. The field of kidney transplantation is one of the costliest fields in the healthcare system and it is paid by the Federal government. Increasing the quality of transplant outcomes has been a major focus for CMS, particularly for underserved populations such as African Americans who already face the worse transplant outcomes. Studies show that implementing personalized medicine practices increases the quality of care, reduces graft rejection and increases graft survival rates. Such results directly translate into reducing the cost of kidney care. In this manuscript I developed a personalized medicine model based on gut microbiome information and gene markers to optimize the administration of an immunosuppressive drug called Tacrolimus. This model shows to be superior than existing models in predicting optimum required dose. In the next step I investigated the role of gut microbiome in kidney transplant outcomes and used the change in the relative abundance of bacterial genera as a tool for predicting graft rejection and graft failure. Finally, the existing policies of insurance coverage for personalized medicine for kidney disease were surveyed. I present an argument that expanding Medicare coverage to personalized medicine for kidney transplant is essential. This 3-essay dissertation presents a package for extending our knowledge of personalized medicine in kidney disease and it offers possible tools for implementing such practices.
