Telemedicine monitoring in the follow-up of kidney transplant recipients: consensus indications from an Italian panel of surgeons and nephrologists after the COVID-19 experience

Abstract

The quality of follow-up has clearly emerged as a key factor for long-term kidney graft survival. Currently, many clinics are facing difficulties in delivering optimal surveillance because of the increased number and complexity of kidney transplant recipients, and because of the COVID-19 pandemic. Additional ways of performing follow-up visits are needed and telemedicine has emerged as a tool to strengthen patient care intensity. Six Italian transplant surgeons and nephrologists convened via teleconference to develop a consensual model of video visits for the follow-up of kidney transplant recipients. Issues discussed were: profile of eligible patients; assessments that can be carried out; video visit organization and medical professionals involved; supporting tools and implementation. The video visit was consensually recognized as the most relevant for the follow-up of kidney transplant recipients. Eligible patients should have basic electronic devices and the skills to correctly use them and be in clinically stable condition. With the exception of physical and instrumental examination, and kidney biopsy, all other assessments are feasible during a video visit and can be implemented by specific training and use of supporting tools. The video visit model is simple and adaptable to most transplant patients. It is not intended to replace face-to-face examinations, but is an additional tool for improving the intensity of follow-up of kidney transplant recipients, which can be integrated into current monitoring protocols. Graphical abstract

Best practices during COVID-19 pandemic in solid organ transplant programs in Spain

“…An adaptation of the post-renal transplant review visits was made to each stage of the COVID-19 pandemic, marked by the rules dictated by the health authorities and experts' committees [ 32 ].…”

Emergency department visits and hospital admissions in kidney transplant recipients during the COVID-19 pandemic: A hospital-based study

“…Despite the fear of contacting COVID-19, we found that ED visits by post-KT patients were not disturbed. A previous study demonstrated that KT recipients had a higher chance of a more severe course of COVID-19 infection than hemodialysis patients[ 18 ]; however, another finding showed that the severity and adverse outcomes were not different between KT recipients and those without for the COVID-19 infection[ 19 ].…”

“…Recently, telemedicine has become one of the most powerful strategies used to follow-up KT recipients[ 18 , 19 ]. Results from Yadav and Singh’s study found that application of telemedicine in the transplant population enhances medication compliance, reduces hospitalization rates, and makes living donor evaluation convenient[ 19 ].…”

Telemedicine for Kidney Transplant Recipients: Current State, Advantages, and Barriers

“…The initiatives for telemedicine for transplant recipients with COVID-19 are limited to a few publications on a hand full of cases. [55][56][57] In these articles, proof of concept was demonstrated, whereby telemedicine helped assess, diagnose, triage, and treat patients with COVID-19 while avoiding a visit to an emergency department or outpatient clinic. However, large-scale studies have not been published.…”