Telemedicine based remote monitoring after liver transplantation: Feasible in a select group and a more stringent control of immunosuppression.

Telemedicine gained interest in liver transplant patients but focused until now on the early post-operative period. This prospective cohort study assessed feasibility, safety, and clinical beneficial effects of a telemedicine based remote monitoring program (TRMP) for the chronic follow-up of adult liver transplant recipients. Between November 2017 and August 2019, a total of 87 of the 115 selected patients (76%) started the TRMP. Over the 2 years study period, none of the patients switched to standard follow-up: 39/87 (45%) continued to do this autonomously and 48/87 (55%) stopped to report their data personally but communicated their lab values to the nurse. The other 28/115 (11%) patients who did not accept the TRMP continued the standard follow-up. There was no difference in educational level between the three groups. Remote monitoring did not result in an increase in liver graft rejection and need of hospitalization. TRMP was associated with a higher number of tacrolimus level determinations and tacrolimus blood level concentrations could be kept lower. In conclusion, our results show that in patients with a stable clinical condition there is a high willingness to participate in TRMP and that this approach is safe. Remote monitoring allowed a stringent follow-up of tacrolimus levels.

Return to work and social participation: does type of organ transplantation matter?

BACKGROUND: Return to work and social participation are objective parameters to evaluate the success of transplantation. Existing reports never compared return to work rates between different organ transplant groups, few European studies were published, and information on patients having a volunteer job or being an active club member is scarce. These outcomes have never been compared with the general population. METHODS: In a cross-sectional sample of 281 kidney, heart, liver, and lung transplant patients, we assessed self-reported return to work (i.e., having a paid job) and social participation (i.e., having a volunteer job or being an active member of a club). These data were compared with the general population. We also explored possible correlates of return to work (multivariable regression analysis). RESULTS: Kidney transplant patients had the highest employment rate (58.6%), followed by heart (43.6%), liver (37.5%), and lung transplant patients (28.1%). Except for kidney patients, these numbers are lower than the 62% population's employment rate. Return to work was more likely if the transplanted organ was other than lung, with younger age at time of transplantation, being male, being married, having a positive perception of one's capability to work, and having worked until at least 1 year before transplant. Volunteer work was similar to the general population (17.4% vs. 21.5%), although less patients were an active club member (28.5% vs. 61%). CONCLUSION: Obtaining a paid or voluntary job posttransplantation is possible and should be strongly recommended by transplant professionals as a meaningful way to contribute to the society.

Should the law on anonymity of organ donation be changed? The perception of liver transplant recipients.

BACKGROUND: Belgian politicians submitted a proposal to rescind the law on anonymity of organ donation and transplantation and facilitate contact between donor families and recipients. It remains uncertain if recipients support this proposal. METHODOLOGY: One liver transplant patient organization (n = 176/249) answered and provided comments on two questions: (i) how satisfied are you with the current principle of anonymity of the identity of the donor and (ii) the law about anonymity should be changed to allow the donor family and the patient to meet. RESULTS: Seventy percent were satisfied/very satisfied with the present law, because of anxiety for emotional involvement or feeling obliged to do something in return, feelings of guilt, and out of mutual respect. Nineteen percent was dissatisfied/very dissatisfied and want to obtain some information about the donor, and directly express their gratitude. Forty-two percent disagreed with a change, because of anxiety for manipulation, feelings of guilt, respect for the privacy, and worry about the donor having a different background. Thirty-six percent wanted to change the law out of curiosity, to express their gratitude, or to facilitate their coping process. DISCUSSION: Prudence to change the law is warranted, as only a minority of patients are in favor of rescinding the anonymity.