Transplant Trial Watch

Telemedicine Based Remote Home Monitoring After Liver Transplantation: Results of a Randomized Prospective Trial.

Lee, T. C., Kaiser, T. E. et al. (2019).

Annals of Surgery [record in progress].


Aims
This study aimed to evaluate the impact of a telemedicine-based home management program (THMP) on patient adherence, hospital readmissions, and quality of life (QOL) after liver transplantation (LT), in comparison to standard of care (SOC).

Interventions
Patients were randomized randomized (1:1) to one of the two posttransplant care strategies: SOC or THMP. The THMP included an electronic tablet and bluetooth devices to support daily text messages, education videos, and video FaceTime capability; data was cyber-delivered into our electronic medical record daily, whereas SOC comprised of standard discharge education provided by the multidisciplinary team.

Participants
106 liver transplant reipients met the inclusion criteria and were enrolled into this study (male and female >18 years; discharged home within 45 days of liver transplant; consented to study participation).

Outcomes
Outcomes assessed included THMP participation, 90-day hospital readmission rate, and quality of life.

Follow-up
90 days.

CET Conclusions
This interesting study investigates the role of telemedicine-supported remote monitoring following liver transplantation. Recipients were randomized to either standard care, or to home monitoring using bluetooth-powered blood pressure, temperature, blood glucose and symptom monitoring, complete with text and video messaging. The authors found that 90-day readmission rates were significantly lower in the telemedicine group, with improvements in physical and general quality of life. These results suggest that closer home monitoring may have real benefit over the periodic outpatient care currently offered post-transplant. Limitations include a lack of information on medication adherence and clinic visits and absence of a health-economic analysis that takes into account additional staff monitoring time. Interestingly, use of video calling and text messaging were low whereas information provision, vital sign monitoring and phone calls were much higher. This provides some insight into the way that patients prefer to interact that can be incorporated into future studies.

Jadad score
3

Data analysis
Per protocol analysis

Allocation concealment
No

Trial registration
ClinicalTrials.gov NCT03878329

Funding source
Non-industry funded