JMIR Publications

ABSTRACT

Background:

Nowadays, the rapidly and stably development of technical ability in liver transplantation(LT). However, the shortage of the critical organ has prompted greater utilization of edge donor grafts, including those donated after circulatory death (DCD), older donors, and hepatic steatosis.Whereas, the increasingly complex landscape of LT has made it difficult to define “optimal” clinical outcomes.

Objective:

The present study aimed to investigate the efficacy of telemedical follow-up management on rapid recovery, hospitalization cost, mortality, and morbidity of patients in LT.

Methods:

The telemedical follow-up management in perioperative of LT in this clinical observation cohort study recruited 110 patients, who received LT between January 1, 2015 and September 30, 2018 in the First Affiliated Hospital of Xi’an Jiao Tong University. The donor livers were derived from donated after circulatory death. The discharged patients who received telemedical advice were randomly assigned to either telemedical follow-up management 2 weeks plus usual follow-up or the usual follow-up only. The follow-up data were up to December 2020.

Results:

A total of 52 cases in the telemedical management group and 50 cases in the usual follow-up group started their assigned care. No differences were detected between the two groups regarding age, model for end-stage liver disease score, operation time, blood loss, and transfusion volume. The length of the initial hospitalization (16.31(SD 3.57) vs 19.12(SD 8.45) (days), P=.03), the expenses of initial hospitalization (382502.36(SD 35115.42) vs 408190.11(SD 85904.12)(yuan), P=.049), and readmission rate within 30 days after discharge (0.08(SD 0.269) vs 0.24(SD 0.431), P=.02) were markedly lower in the telemedical management group than in the usual follow-up group (P<.05). 3 cases were deceased in the telemedical management group and 5 cases deceased in the usual follow-up group before completion of a 12-month visit. Also, the long-term survival follow-up data were recorded up to December 31,2020. The postoperative survival rates in the telemedical management group at 1-, 2-, and 3-years have reached 94.23%, 94.23%, and 65.4%, respectively. The postoperative survival rates in the usual follow-up group at 1-, 2-, and 3-years have reached 90%, 84%, and 60%, respectively. However, there was no significant difference in long-term visit cumulative survival rate between the two groups (P>.05).

Conclusions:

The telemedical follow-up management in patients post-LT could promote rapid recovery and reduce hospital costs, which might be due to high-efficiency in perioperative and follow-up management. Moreover, the survival rate of patients in the telemedical follow-up group was at a high level in the first 3 years post-LT, we was aware of that it have to do with the enhancement of patient self-management and medication compliance through the telemedicine follow-up management system. It is crucial that in improving the patients' HRQL and achieving long-term outcomes in patients.