Telemedicine for Follow-up Management of Patients After Liver Transplantation: Cohort Study

Abstract

Background Technical capabilities for performing liver transplantation have developed rapidly; however, the lack of available livers has prompted the utilization of edge donor grafts, including those donated after circulatory death, older donors, and hepatic steatosis, thereby rendering it difficult to define optimal clinical outcomes. Objective We aimed to investigate the efficacy of telemedicine for follow-up management after liver transplantation. Methods To determine the efficacy of telemedicine for follow-up after liver transplantation, we performed a clinical observation cohort study to evaluate the rate of recovery, readmission rate within 30 days after discharge, mortality, and morbidity. Patients (n=110) who underwent liver transplantation (with livers from organ donation after citizen's death) were randomly assigned to receive either telemedicine-based follow-up management for 2 weeks in addition to the usual care or usual care follow-up only. Patients in the telemedicine group were given a robot free-of-charge for 2 weeks of follow-up. Using the robot, patients interacted daily, for approximately 20 minutes, with transplant specialists who assessed respiratory rate, electrocardiogram, blood pressure, oxygen saturation, and blood glucose level; asked patients about immunosuppressant medication use, diet, sleep, gastrointestinal function, exercise, and T-tube drainage; and recommended rehabilitation exercises. Results No differences were detected between patients in the telemedicine group (n=52) and those in the usual care group (n=50) regarding age (P=.17), the model for end-stage liver disease score (MELD, P=.14), operation time (P=.51), blood loss (P=.07), and transfusion volume (P=.13). The length and expenses of the initial hospitalization (P=.03 and P=.049) were lower in the telemedicine group than they were in the usual care follow-up group. The number of patients with MELD score ≥30 before liver transplantation was greater in the usual care follow-up group than that in the telemedicine group. Furthermore, the readmission rate within 30 days after discharge was markedly lower in the telemedicine group than in the usual care follow-up group (P=.02). The postoperative survival rates at 12 months in the telemedicine group and the usual care follow-up group were 94.2% and 90.0% (P=.65), respectively. Warning signs of complications were detected early and treated in time in the telemedicine group. Furthermore, no significant difference was detected in the long-term visit cumulative survival rate between the two groups (P=.50). Conclusions Rapid recovery and markedly lower readmission rates within 30 days after discharge were evident for telemedicine follow-up management of patients post–liver transplantation, which might be due to high-efficiency in perioperative and follow-up management. Moreover, telemedicine follow-up management promotes the self-management and medication adherence, which improves patients’ health-related quality of life and facilitates achieving optimal clinical outcomes in post–liver transplantation.

Reabilitação Baseada em Exercícios para Pacientes Pré e Pós Transplante de Órgãos Sólidos

“…This model allows more people to engage in an exercise program, receive guidance from a qualified professional, and have periodic face-to-face or teleconsultation consultations. 12 The results found by the authors reinforce the importance of the supervised program but emphasize that any type of treatment will be effective as long as the patient proposes to perform it. 11 In addition to the limitations described by the authors, the fact that, in the same study, recipients of different organs were approached have a pathophysiological inheritance that can directly influence rehabilitation outcomes.…”

SARS-CoV-2 infection: a hurricane that does not ignore chronic hepatitis

“…A wider use of telemedicine will be useful in reducing or preventing these negative events from happening in subsequent waves of the pandemic. It has also been pointed out that the use of telemedicine is useful in simplifying the management of liver transplant recipients and in improving their outcome [ 46 , 47 , 49 – 52 ], as well as allowing a multi-disciplinary approach for early diagnosis and monitoring of HCC in cirrhotic patients [ 53 ]. However, a poor ability to use internet and other audiovisual media can be an obstacle to a wide use of telemedicine, as verified by a retrospective cohort study performed by Wegermann et al [ 49 ] showing a low ability of the elderly and non-Hispanic blacks to use telemedicine.…”

Pragmatic solutions to enhance self-management skills in solid organ transplant patients: systematic review and thematic analysis

“…In another study, an interactive voice response system was developed to enhance self-management behaviors in kidney transplant recipients [40]. In six studies, researchers developed web-based portals to enhance patient care and symptom monitoring via electronic questionnaires and forms [41][42][43][44][45][46]. In this category, programs exchange patient information with healthcare providers periodically or in real-time.…”

“…Outcome measures devoted to transplantation outcomes included readmission rate (eight studies) [31,32,34,35,45,62,65,68], abnormal health indicator Two five-item scales to assess the patient's belief regarding the need for prescribed medication for controlling their disease and their concerns about adverse side effects It was used to evaluate the specific problems associated with organ transplantation in five subscales such as "worry", "guilt", "disclosure", "responsibility", and "adherence" It is a seven-item questioning item to assess a patient's adherence to treatment reports (12 studies) [28,31,34,37,40,53,57,60,62,65,68], survival rate (six studies) [31,34,37,45,62,64], organ rejection (six studies) [32,35,37,54,64,65], episodes of infection (two studies) [35,60], unplanned returns to the operating room (two studies) [37,68], and hospital charge (three studies) [28,45,51]. Metrics related to self-management tasks and behaviors of patients included self-efficacy (25 studies) [31-35, 37, 38, 40, 42, 46, 48, 49, 51, 54, 57, 58, 61, 63, 64, 66-69], medication adherence (19 studies)…”

“…Metrics related to system and program usage included ease of use (22 studies) [28, 32-35, 38, 40, 41, 44, 46, 49, 53, 58, 59, 61, 63, 65-69], usefulness (24 studies) [28, 29, 33-35, 38, 40, 41, 44-46, 48, 53, 58, 59, 63, 65-67], usage rate (nine studies) [33,38,40,41,55,58,[64][65][66], trustiness or reliability (11 studies) [28, 29, 32, 37, 41, 44-46, 48, 49, 61], adherence to system recommendation (10 studies) [28,29,33,38,41,45,65,67,68], acceptability (21 studies) [29, 33-35, 38, 40, 41, 45, 46, 48, 49, 53-55, 58, 61, 65, 66], and intention to use (17 studies) [29,30,34,35,37,38,40,41,48,49,58,61,64,65,67]. All of these indicators, based on their effectiveness in the reviewed studies, are described in Table 4.…”