A Cost Comparison for Telehealth Utilization in the Kidney Transplant Waitlist Evaluation Process.

BACKGROUND: There have been limited publications on telehealth utilization in transplantation with no prior reports of telehealth-related costs for pretransplant evaluations. The aim of this study is to compare costs throughout the evaluation process for those patients assessed initially by telehealth with those seen in-person. METHODS: All patients approved for kidney transplant waitlist evaluation at our center from March 2013 thru May 2016 with decisions were included in this study. Patients approved for evaluation were scheduled for either an initial telehealth or in-person visit, partly based on patient factors. Clinically related and travel-related costs were calculated. Time estimates for patient time needed to complete visit, time from application approval to initial visit, and time from application approval to decision were obtained. Comparisons were made using t tests. RESULTS: Thirty-nine months were included for 302 patients. All categories of clinically or travel-related costs were significantly less for the telehealth cohort (P < 0.0001). Total mean cost per patient was US $656.11 versus US $1108.91 for the cohort initially evaluated by telehealth versus in-person (P < 0.001). The time needed to complete an evaluation (1.7 vs 2.4 days, P < 0.001) and the time to initial evaluation (51.4 vs 87.9.0 days, P < 0.001) were significantly less in the telehealth cohort. The cohort seen by telehealth was older with increased comorbidities (<0.001). CONCLUSIONS: As telemedicine applications continue to proliferate, we present our experience with telehealth for initial kidney transplant waitlist evaluations with associated reductions in cost and time which may also improve access to transplantation.

Solid organ transplantation at the National Institutes of Health: development of a research-based transplantation practice.

The National Institutes of Health has established a clinical transplant research program focusing on translational research in kidney transplantation. The program has been developed with a multidisciplinary approach under a common administrative structure that integrates transplant physicians and surgeons with clinical laboratory and data analysis support personnel. The program has achieved excellent clinical outcomes despite focusing exclusively on investigational methods and serving a diverse and medically complex patient population. Novel approaches toward consenting, computer integration, and tissue acquisition have been layered over interventional and observational studies to serve the scientific mission while delivering quality transplant care.

Objective, real-time, intraoperative assessment of renal perfusion using infrared imaging.

Allograft ischemia induces delayed graft function and is correlated with increasing rates of rejection. There is not currently a way to objectively measure the effects of ischemia in real-time, nor to relate therapies combating reperfusion injury with their intended effects. An infrared (IR) method utilizing a focal plane array detector camera was developed for real-time intraoperative IR imaging of renal allografts, and evaluated in a pilot trial to quantify perfusion in recipients of live (n = 8) and cadaveric donor (n = 5) allografts. Digital images were taken for 3-8 min postreperfusion. Image data were compared to ischemic time and allograft function to assess potential clinical relevance. Cold ischemic time ranged from 0.5 to 29 h and was bimodally distributed between living and cadaveric donors. Renal rewarming time (RT) as determined by IR imaging correlated with cold ischemic time (p < 0.001, R 2 = 0.81), and predicted the subsequent return of renal function with RT negatively correlated to the regression slopes of creatinine (p = 0.02, R 2 = 0.38) and BUN (p = 0.07, R 2 = 0.26). Intraoperative IR imaging noninvasively provides clinically relevant real-time whole kidney assessment of reperfusion. This technology may aide in the objective assessment of therapies designed to limit reperfusion injury, and allow for quantitative assessment of allograft ischemic damage.