-Clinical trial pilot study -Assess improvement in adherence after the mobile phone support intervention. (1919 Sayegh CS, Szmuszkovicz JR, Menteer J, Sherer S, Thomas D, Lestz R, et al. Cell phone support to improve medication adherence among solid organ transplant recipients. Pediatric Transplantation. 2018;22(6). https://doi.org/10.1111/petr.13235 https://doi.org/10.1111/petr.13235...
) LE = III (clinical issue of intervention/treatment) |
N=8 non-adherent adolescent and young adult recipients. Mean age of 16.76 years, post-transplantation from 101 to 5548 days. |
Patients with a level of medication adherence lower than 80% and blood levels of the immunosuppressant lower than the stipulated parameter also participated in the study. |
The team provided Telephone support daily, in which they were asked about the time the immunosuppressant, Tacrolimus, was taken. In case of non-adherence, the reason was asked to justify it. In addition, daily reminders were sent about the doses, which could be adjusted according to the level of the drug in the bloodstream, with notifications being sent to the team about the altered levels. |
On average, 12.63 (SD = 14.41) blood levels of immunosuppressants were taken in the 24 weeks prior to intervention enrollment, and 6.88 (SD = 4.45) were taken in the 24 weeks after registration, excluding the levels taken during a period of hospitalization. Pre-post analysis indicated an improvement in adherence, social support and depression rates. |
-Clinical trial pilot study. -Develop SMS-based mobile intervention to reduce the incidence of alcohol relapse and decrease stress in liver transplant candidates. (18) LE = III (clinical issue of intervention/treatment) |
N=15 transplant candidates. Mean age of 50.8 years. |
Have alcoholic liver disease and at least 1 episode of alcohol consumption in the previous year. Being on the waiting list and providing urine samples to assess alcohol levels. |
For 8 weeks, participants in the intervention group, in addition to weekly consultations with psychologists, received daily text messages, 3 text messages per day in the first four weeks of the study and 3 messages per week in the last four weeks, containing encouragement for sobriety, and they demanded a response. The responses were analyzed according to five domains, namely, (1) identification of desires; (2) humor; (3) identification of high-risk situations; (4) coping strategies, and the fifth domain, “general” data were compared to the control group (usual care). |
According to the self-report satisfaction survey, the improvement in stress levels and the ease in maintaining abstinence (M = 3.67, SD = 1.51), dealing with cravings (M = 3.67, SD = 1.51) and stress (M = 3.67, SD = 1.37). Only 1 participant tested positive on the breathalyzer, demonstrating that the intervention helped maintain sobriety in most participants. |
- Descriptive study. -Describe the use of a remote monitoring system to monitor transplant recipients during the pandemic. (20) LE = IV (clinical question of intervention/treatment) |
N=63 transplant recipients. |
It included all participants who voluntarily registered in the application. |
The TRANSPLANT.NET application made it possible to remotely control the clinical conditions of the patients, making it possible for the medical assessment to be made through indicators reported daily (dose of medication taken, signs and symptoms, subjective symptoms such as itching, weakness, etc.). The application has a personal library with themes customized according to the needs of patients. |
During 10 months of analysis of the TRANSPLANT.NET application, 63 participants were evaluated. There was a decrease in the number of errors in the medication regimen, and patients reported greater ease in finding reliable information about their condition, in addition to contacting the medical team online, improving communication between the group and patients. |
- Non-randomized clinical trial. -Evaluate the degree of involvement and use of the Track Your Med® application; TYM, as a method of controlling and promoting adherence to immunosuppressive treatment(2323 Melilli E, Cestone G, Revuelta I, Meneghini M, Lladó L, Montero N, et al. Adoption of a novel smart mobile-health application technology to track chronic immunosuppression adherence in solid organ transplantation: Results of a prospective, observational, multicentre, pilot study. Clin Transplant. 2021;35(5):142-78. https://doi.org/10.1111/ctr.14278 https://doi.org/10.1111/ctr.14278...
) LE = III (clinical issue of intervention/treatment) |
N=90 receivers. Participants with 6 months of stable graft function after transplantation were included. |
Outpatients from two transplant centers in Barcelona. The only requirement was to own a smartphone. |
The patient received several QR-CODE labels pasted on the medication boxes and should be scanned daily using the TrackYourMed application, which automatically generated reminders for the doses for the next few days. By scanning the code and registering the day’s adherence, it was possible to include additional information such as taking the dose late, medication not taken or medication in a different dose. |
61 (68%) used the app regularly. During the 6-month follow-up, correct doses (CIN), mistimed entries (OUT), and missed doses (MIS) varied between 69%-76%, 12%-19%, and 9%-12%, respectively. |
-Prospective cohort study. -Evaluate the safety, feasibility and beneficial clinical effects of a remote monitoring program (TRMP). (2121 Koc Ö M, Pierco M, Remans K, Van den Hende T, Verbeek J, Van Malenstein H, et al. Telemedicine based remote monitoring after liver transplantation: Feasible in a select group and a more stringent control of immunosuppression. Clin Transplant. 2021;36(1):144-94. https://doi.org/10.1111/ctr.14494 https://doi.org/10.1111/ctr.14494...
) LE = IV (clinical issue of intervention/treatment) |
N=115 participants Use of an online platform (via a website or mobile application) for communication with participants (Mynexuzhealth) and Wintermute (clinical decision support system). Mean age of 59.1 years. |
Participants aged ≥ 18 years Recipients transplanted more than 12 months ago and under outpatient follow-up during the study data collection period. |
The Mynexuzhealth application allowed communication with patients (access to consultation dates and test results). The Wintermute system allowed monitoring, according to the values entered by the patient, such as daily adherence to the Tracrolimus medication, signs and symptoms. The information was transmitted to the medical team to maintain a pre-established ideal parameter. Every four months, new blood tests were requested for possible readjustments in the dosage, which were also communicated to the patient through the application. Patients were interviewed about challenges and coping strategies experienced after liver transplantation. The interviews were conducted using a semi-structured script and were digitally recorded and transcribed. Dedoose software was used for analysis. A descriptive analysis was also performed in addition to the qualitative one. |
The remote program decreased the need for outpatient consultations (P< 0.001), decreasing the risk of the transplanted patient being exposed to COVID-19. When analyzing blood concentrations of Tracrolimus, it was possible to maintain lower serum levels by having fewer missed doses with fewer corrections (P = 0.038 and P = 0.002) with no effect on the rejection rate in the pre-and post-intervention analysis. The program allowed rigorous monitoring of serum levels of Tacrolimus. |
- Qualitative study. -Assess liver receptor challenges and survival strategies used to overcome challenges. (2222 Lieber SR, Kim HP, Baldelli L, Evon DM, Teal R, Nash R, et al. What Liver Transplant Recipients Want in a Smartphone Intervention to Enhance Recovery: Prototype for the LiveRight Transplant App. Liver Transpl. 2021;27(4):584-9. https://doi.org/10.1002/lt.25967 https://doi.org/10.1002/lt.25967...
) LE = VI (clinical issue of intervention/treatment) |
N=20 liver transplant recipients. |
- Age ≥ 18 years old At least 3 to 6 months post-transplant period |
The Mynexuzhealth application allowed communication with patients (access to consultation dates and test results). The Wintermute system allowed monitoring, according to the values entered by the patient, such as daily adherence to the Tracrolimus medication, signs and symptoms. The information was transmitted to the medical team to maintain a pre-established ideal parameter. Every four months, new blood tests were requested for possible readjustments in the dosage, which were also communicated to the patient through the application. Patients were interviewed about challenges and coping strategies experienced after liver transplantation. The interviews were conducted using a semi-structured script and were digitally recorded and transcribed. Dedoose software was used for analysis. A descriptive analysis was also performed in addition to the qualitative one. |
90% of the participants had a smartphone, with alarm reminders to take medication (65%) being the most used function. 65% used the Epic MyChart system to communicate with the team. 80% were interested in apps to help with their recovery. The study supported the development of the LiveRight Transplant application to improve patient education, facilitate adherence and improve coordination of post-transplant care. |