Telemedicine based remote monitoring after liver transplantation: Feasible in a select group and a more stringent control of immunosuppression

Abstract

Telemedicine gained interest in liver transplant patients but focused until now on the early post-operative period. This prospective cohort study assessed feasibility, safety, and clinical beneficial effects of a telemedicine based remote monitoring program (TRMP) for the chronic follow-up of adult liver transplant recipients. Between November 2017 and August 2019, a total of 87 of the 115 selected patients (76%) started the TRMP. Over the 2 years study period, none of the patients switched to standard followup: 39/87 (45%) continued to do this autonomously and 48/87 (55%) stopped to report their data personally but communicated their lab values to the nurse. The other 28/115 (11%) patients who did not accept the TRMP continued the standard follow-up. There was no difference in educational level between the three groups. Remote monitoring did not result in an increase in liver graft rejection and need of hospitalization. TRMP was associated with a higher number of tacrolimus level determinations and tacrolimus blood level concentrations could be kept lower. In conclusion, our results show that in patients with a stable clinical condition there is a high willingness to participate in TRMP and that this approach is safe. Remote monitoring allowed a stringent follow-up of tacrolimus levels.

Telehealth interventions in patients with chronic liver diseases: A systematic review

“…We also think that the use of TH in the initial transplant evaluation can shorten or substitute some of the inperson consultations, such as the transplant hepatology visit for stable chronic liver disease suffering from HCC, the psychosocial evaluation and, if a handgrip dynamometer or measurement tape is available on prior remote consultations, the nutritional assessment. Moreover, in the posttransplant setting, telemedicine offers an equally effective option for close follow-up, without differences in pertinent outcomes such as rates of graft rejection, hospital readmission, and overall mortality 47,49 …”

“…Moreover, in the posttransplant setting, telemedicine offers an equally effective option for close follow-up, without differences in pertinent outcomes such as rates of graft rejection, hospital readmission, and overall mortality. [47,49] Likewise to HCV, TH has shown equal efficacy in the management of HBV. [42] In patients with NAFLD, various TH modalities involving behavioral change and nutritional counseling resulted in improved or equivalent weight loss.…”

“…The studies in our review did not collect data on whether there were increased phone calls or time required by staff for follow-up of TH encounters. [48,49] Future research should aim to guide the integration of TH within routine care as providers need to accurately identify the frequency and duration of telemedicine visits in conjunction with the frequency of face-to-face interactions. [50] TH must also consider the provider and the ability to clinically integrate virtual platforms into routine patient care.…”

Liver transplantation during COVID-19: Adaptive measures with future significance

“…Prior studies have demonstrated the usefulness of telehealth in heart failure and diabetic glucose regulation, exhibiting similar results to telephone follow-up and in-patient visits[ 51 ]. With regards to liver transplantation, one study showed that long-term follow-up via telehealth had comparable outcomes to in-person follow-up, with the only drawback of requiring stricter control over tacrolimus levels[ 52 ]. Importantly, 75% of physically stable transplant patients expressed interest in telemonitoring, with distance from the hospital being a major contributing factor.…”

Multimodal Remote Home Monitoring of Lung Transplant Recipients during COVID-19 Vaccinations: Usability Pilot Study of the COVIDA Desk Incorporating Wearable Devices

“…The use of RPM in LTRs is primarily motivated by the fact that it has the potential to improve patient outcomes, including better and earlier diagnosis of complications, increase quality of life by facilitating transparency and reassurance of the current patient condition and reducing the personal consultation frequency [ 1 , 2 , 3 ]. Some telemedical remote monitoring programs do not rely on measuring devices but focus only on information exchange based on software applications using mobile devices or regular computers in solid organ transplantation recipients [ 5 ]. Only a small number of randomized controlled trials have investigated mobile health interventions in LTRs focusing on patient education, spirometry, self-management and a computer-based decision system for triage [ 6 , 7 , 8 , 9 ].…”