Key takeaways:

• Performing routine tests at local clinics and sharing results through EMRs could help facilitate collaborative efforts.
• Health literacy and economic barriers can limit uptake of digital health tools.

Digital health tools and collaboration with local clinics may help to improve patient care after transplantation, according to experts.

Existing and emerging technologies, including remote patient monitoring and wearable devices, could help to reduce trips to a transplant center after transplantation, according to Richard Knight, MD, FACS, senior director of medical affairs, medical affairs, transplant diagnostics, Thermo Fisher Scientific and Tina Liedtky, president of transplant diagnostics business at Thermo Fisher Scientific.

Patients, clinicians and manufacturers are exploring the role of digital health tools in posttransplant care. Image Adobe Stock

Healio spoke with Knight and Liedtky about the role of local clinics and digital health tools in patient care after transplantation.

Healio: What kinds of routine tests are needed for patients after a kidney transplant, and what tools are available to help with these tests?

Knight: Continuous glucose monitoring is important, as diabetes control is more difficult after transplantation, and there’s not an endless supply of endocrinologists to manage these patients. Blood pressure monitoring is also necessary, as almost every kidney transplant patient has an issue with hypertension after transplantation.

We are at the point where we have at-home urine tests, which can be collected by the patient and sent to the lab. The hope ultimately is that we can do the same thing with blood testing for this population.

Healio: How can local clinics and transplant centers collaborate on a patient’s care after transplantation?

Knight: One of the simplest ways that they can collaborate is through integration of their electronic medical records. Many transplant programs and hospitals are part of a larger network, so it’s entirely possible for patients to avoid coming back to the transplant center and instead get blood testing and monitoring done at a local hospital. Then, the physician can get immediate access to their lab tests.

Liedtky: Getting work done at a local clinic can also help with transportation issues, which has been one of the biggest challenges in posttransplant care. If the patient can go to a nearby clinic to do their actual blood work and connect with their transplant physician via telemedicine, that can be more convenient for them.

Healio: What is the role of digital health/wearable devices in posttransplant care?

Knight: I’m not aware of any widely available wearable devices for posttransplant monitoring, but having wearable devices for it could be hugely important. We do have continuous glucose monitoring devices, which are very accurate at monitoring glucose levels and allow physician to access that data.

Liedtky: Agreed. Continuous glucose monitors have really changed the way that patients with diabetes manage their ongoing care. Although there are no wearable devices right now specifically geared toward transplant patients, these patients have comorbidities like diabetes or cardiac issues that wearable devices can help address. For example, smartwatches are now able to catch arrhythmias. Being able to monitor these kinds of metrics may help clinicians get a better picture of the patient’s condition. That said, all of that information needs to be centralized to one place, such as the EMR.

A more common model in transplantation right now is remote patient monitoring. There are programs where patients use an at-home monitoring kit and a smartphone app linked to a patient record that allows clinicians to see patients’ physiologic data and adjust medications remotely.

Healio: Are there any economic or health literacy barriers that need to be addressed before patients may benefit from these tools?

Knight: Yes. In recent years, when we switched to doing virtual visits, many patients struggled with using Zoom, Teams or other video call platforms. We resorted to simply calling the patient on the phone, and that worked well. So yes, there can be problems with patient education when learning how to use these new devices.

The other issue that is becoming problematic for physicians is that there’s so much data now in the EMR. For example, a patient could have a test or imaging done at a local clinic that their transplant team is not aware of.

There’s just so much information now being collected that physicians have trouble staying on top of it. In a big transplant program where you might be doing 300 transplants a year, it’s a lot of people to keep track of. Potentially, this may be an opportunity for AI to help physicians track trends in patients and create warning signals for their team.

Liedtky: Cost can be a barrier. A lot of devices like the continuous glucose monitors are reimbursed by CMS, Medicare, Medicaid and some private payers, but some are only partially reimbursable or not at all. In these cases, the burden is put on the patient.

Education about these devices is dependent on manufacturers like us.

As more of these digital health solutions pop up, there are still concerns around cybersecurity and how you move data around while staying HIPAA compliant, even within one’s own institution. If a device is AI-enabled and it gives a wrong answer, who is liable? Is it the manufacturer, the clinician? These questions need to be sorted out, and clinicians must use their judgment.

Healio: What are other future innovations we may see regarding posttransplant kidney care?

Knight: A wearable device that could manage BP would be hugely important. However, you can’t get away from the fact that patients will need to get blood testing done to monitor tacrolimus levels.

Thermo Fisher has introduced a pharmacogenetic test that will help physicians to carefully target appropriate tacrolimus levels, which likely will reduce the number of blood tests required. We have begun to introduce urine-based surveillance assays that can potentially predict the risk of rejection earlier than conventional blood testing. Such testing can be done at home by the patient, again, avoiding the need to visit a clinic. More importantly, there is data to suggest that these tests will allow physicians to avoid the need for kidney biopsies. A number of studies have shown that the use of new molecular surveillance tests could potentially reduce the need for a kidney biopsy. There is real promise that the introduction of these new devices and surveillance tests will make life easier for transplant patients.

Liedtky: Another thing we often think about is if we could have an AI-enabled application to overlay all of a patient’s data together. Longitudinally, we could see when a patient took a test on a certain date or had surgery, what medications they are on over time, vital signs, etc. Having everything all in one place would be ideal to put all that information together and help clinicians decide what to do.

For more information:

Richard Knight, MD, FACS, can be reached at nephrology@healio.com.

Tina Liedtky can be reached at nephrology@healio.com.