Tian Min, Wang Bo, Xue Zhao, Dong Dinghui, Liu Xuemin, Wu Rongqian, Yu Liang, Xiang Junxi, Zhang Xiaogang, Zhang Xufeng, Lv Yi
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
JMIR Med Inform. 2021 May 17;9(5):e27175. doi: 10.2196/27175.
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.
We aimed to investigate the efficacy of telemedicine for follow-up management after liver transplantation.
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.
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).
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.
肝脏移植的技术能力发展迅速；然而，可用肝脏的短缺促使人们使用边缘供体移植物，包括循环死亡后捐赠的肝脏、老年供体和肝脂肪变性的肝脏，从而难以确定最佳临床结果。
我们旨在研究远程医疗在肝移植术后随访管理中的疗效。
为了确定远程医疗在肝移植术后随访中的疗效，我们进行了一项临床观察队列研究，以评估恢复率、出院后30天内的再入院率、死亡率和发病率。接受肝移植（使用公民死亡后器官捐赠的肝脏）的患者（n = 110）被随机分配，一组除接受常规护理外，还接受基于远程医疗的随访管理2周，另一组仅接受常规护理随访。远程医疗组的患者免费获得一台机器人用于2周的随访。患者使用机器人每天与移植专家互动约20分钟，专家评估呼吸频率、心电图、血压、血氧饱和度和血糖水平；询问患者免疫抑制剂药物使用情况、饮食、睡眠、胃肠功能、运动和T管引流情况；并推荐康复锻炼。
远程医疗组（n = 52）和常规护理组（n = 50）在年龄（P = 0.17）、终末期肝病模型评分（MELD，P = 0.14）、手术时间（P = 0.51）、失血量（P = 0.07）和输血量（P = 0.13）方面未检测到差异。远程医疗组的首次住院时间和费用（P = 0.03和P = 0.049）低于常规护理随访组。肝移植前MELD评分≥30的患者数量在常规护理随访组中多于远程医疗组。此外，远程医疗组出院后30天内的再入院率明显低于常规护理随访组（P = 0.02）。远程医疗组和常规护理随访组术后12个月的生存率分别为94.2%和90.0%（P = 0.65）。远程医疗组早期发现并及时处理了并发症的警示信号。此外，两组之间的长期随访累积生存率未检测到显著差异（P = 0.50）。
肝移植患者的远程医疗随访管理显示出快速恢复且出院后30天内再入院率明显降低，这可能归因于围手术期和随访管理的高效性。此外，远程医疗随访管理促进了自我管理和药物依从性，提高了患者的健康相关生活质量，并有助于在肝移植后实现最佳临床结果。
