Abuzeineh Mohammad, Muzaale Abimereki D, Crews Deidra C, Avery Robin K, Brotman Daniel J, Brennan Daniel C, Segev Dorry L, Al Ammary Fawaz
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Transplant Proc. 2020 Nov;52(9):2620-2625. doi: 10.1016/j.transproceed.2020.07.009. Epub 2020 Jul 16.
Kidney transplant recipients who develop symptoms consistent with coronavirus disease 2019 (COVID-19) are bringing unique challenges to health care professionals. Telemedicine has surged dramatically since the pandemic in effort to maintain patient care and reduce the risk of COVID-19 exposure to patients, health care workers, and the public. Herein we present reports of 3 kidney transplant recipients with COVID-19 who were managed using telemedicine via synchronous video visits integrated with an electronic medical record system, from home to inpatient settings. We demonstrate how telemedicine helped assess, diagnose, triage, and treat patients with COVID-19 while avoiding a visit to an emergency department or outpatient clinic. While there is limited information about the duration of viral shedding for immunosuppressed patients, our findings underscore the importance of using telemedicine in the follow-up care for kidney transplant recipients with COVID-19 who have recovered from symptoms but might have persistently positive nucleic acid tests. Our experience emphasizes the opportunities of telemedicine in the management of kidney transplant recipients with COVID-19 and in the maintenance of uninterrupted follow-up care for such immunosuppressed patients with prolonged viral shedding. Telemedicine may help increase access to care for kidney transplant recipients during and beyond the pandemic as it offers a prompt, safe, and convenient platform in the delivery of care for these patients. Yet, to advance the practice of telemedicine in the field of kidney transplantation, barriers to increasing the widespread implementation of telemedicine should be removed, and research studies are needed to assess the effectiveness of telemedicine in the care of kidney transplant recipients.
出现与2019冠状病毒病（COVID-19）相符症状的肾移植受者给医护人员带来了独特挑战。自疫情以来，远程医疗急剧增加，以维持患者护理并降低患者、医护人员和公众接触COVID-19的风险。在此，我们报告3例COVID-19肾移植受者的情况，他们通过与电子病历系统集成的同步视频问诊在家中及住院环境下接受了远程医疗管理。我们展示了远程医疗如何帮助评估、诊断、分流和治疗COVID-19患者，同时避免前往急诊科或门诊诊所。虽然关于免疫抑制患者病毒 shedding 持续时间的信息有限，但我们的研究结果强调了在对已从症状中康复但核酸检测可能持续呈阳性的COVID-19肾移植受者的随访护理中使用远程医疗的重要性。我们的经验强调了远程医疗在管理COVID-19肾移植受者以及为这类病毒 shedding 时间延长的免疫抑制患者维持不间断随访护理方面的机会。远程医疗可能有助于在疫情期间及之后增加肾移植受者获得护理的机会，因为它为这些患者提供了一个及时、安全且便捷的护理平台。然而，为了推进远程医疗在肾移植领域的应用，应消除阻碍远程医疗广泛实施的障碍，并且需要开展研究以评估远程医疗在肾移植受者护理中的有效性。
