TABLE 1.

Studies on various topics of telemedicine for kidney transplant recipients, in chronological order

Author	Year	No. of patients	Topics	Design/objective	Instruments	Results	Concerns
Connor et al17	2011	123	Chronic care	Case study, description of current practice BP and weight taken at home or at local hospital Blood test taken beforehand	Telephone consultation 3-monthly over a 3-y period with only once a year face-to-face contact	Two patients preferred face-to-face only. No report of patient safety issues In 30 patients, a mean of 39 km and 8 kg CO2-equivalent saved per teleconsultation	No data on adherence to telephone consultation nor full economic analysis Loss of visual clues to a patient’s well-being Service is only offered to patient with 12-mo stable graft function
McGillicuddy et al9	2013	19	Medication adherence BP monitoring	Proof-of-concept randomized controlled trial (3 mo follow-up) to assess patient and provider acceptability, feasibility of mobile phone–based remote monitoring	Smartphone (Motorola Droid X) Wireless smartphone-enabled) medication tray (Maya MedMinder) Wireless (Bluetooth-enabled) BP monitor (Fora D15b).	Instruments safe, highly acceptable, and useful to patients and providers At 3 mo, significantly better medication adherence (94% vs 57%) and lower systolic BP (122 vs 139 mm Hg)	Limited inclusivity (of 55 approached patients, only 20 participated and were randomized) Costs ($45 a mo) 23% device failure (Maya MedMinder)
Aberger et al18	2014	66	BP monitoring	Management of BP in kidney transplant recipients, single-arm study	BP monitor (model UA-767PC; A&D Medical, San Jose, CA) Upload to home computer and Good Health Gateway Patient Portal	Significant reductions in average systolic and diastolic BP (6.0 and 3.0 mm Hg, respectively) after 30 d	Lack of computer access Limited computer literacy Patient forgetfulness, apathy, or motivational decline over time Obesity (cuff size) Lack of understanding of importance of blood pressure management
McGillicuddy et al11	2015	18	BP monitoring	Follow-up (12 mo posttrial) of the above-mentioned proof-of-concept trial9	See above9	Lower systolic BP in eHealth group (132 vs 154 mm Hg) sustained for 12 mo posttrial	None, but more former eHealth users reported using various methods to assist adherence
Schmid et al19	2017	46	Medication adherence Chronic and acute care	Randomized trial comparing standard posttransplant care with telemedicine-supported case management	Touch screen monitors (non-mobile), real-time video consultation, combined with telemedical education, support, and coaching	At 1 y less nonadherence in the telemedicine group (17% vs 57%) and less acute unplanned hospitalization (median 0 vs 2) and shorter hospital stays (median 0 vs 13 d)	Extra staff needed (50% part-time transplant nurse), but cost-effective No standard reimbursement of costs Limited to living donor kidney recipients Data protection laws prohibited tablets with software for mobile telemonitoring
Levine et al20	2019	108	Medication adherence	Cohort study	Mobile app Transplant Hero and Pebble Smart watch Technology	No difference in coefficient of variability of tacrolimus (32%–36%)	No adherence to technology was analyzed
Han et al21	2019	138	Medication adherence	Randomized trial comparing adherence (BAASIS and the VAS) via mobile app vs standard of care (education)	Mobile app (Adhere4U for android) for medication management with visual and auditory reminders The app also included education on immunosuppression	At 6 mo no difference in rate of nonadherence (app group, 65% vs 62%; OR 1.14; 95% CI, 0.53-2.40) No difference between BAASIS and VAS	Low rate of patient engagement; app use only 12% at 6 mo Patients <1 y posttransplant were excluded, as were patients aged >70 y In all of the 1163 eligible patients, 138 were randomized
Udayaraj et al22	2019	168	Chronic and acute care	Plan do study act for a teleconsultation over telephone services with home BP measurements	Not described	Less nonattendance compared with face-fo-face (6.9% vs 2.9%) 98% surveyed patients (n = 97) were satisfied with teleconsulting A mean of 36.4 miles saved on motorized travel Saving of £6060 in total (excluding external blood sampling)	Ordering, cost, and availability of blood tests during teleconsultation No definitive cost-benefit analysis, including all healthcare-related cost
Andrew et al23	2020	45	Chronic care	Benefits of telehealth on patient-centered outcomes	Care provided via a telehealth platform (Health Direct Videocall) on any device and a dedicated support team	95% of patients felt that telehealth was comparable with face-to-face consultation Telehealth saved patients a total of 203 202 km in travel distance, 2771 h car travel time, and approximately Australian $31 048 in petrol costs	Unknown percentage of suitable patients No transfer of data on BP/heart rate and weight Some observations are taken by general practitioners or nurses at local hospitals
Varsi et al24	2021	18	Chronic care	Benefits and challenges from the perspectives of patients and healthcare providers of video consultation	Video consultation (Norwegian Health Network Cisco meeting application) on PC, tablet, or smartphone Measure own weight and BP, instrument not specified	Main benefits: reduced travel time and costs, less focus on being chronically ill	Reoccurring technical challenges Necessity to go to hospital to have blood samples drawn
Lambooy et al25	2021	64	Chronic care	Single-center, prospective, 2-y longitudinal, case–control study on feasibility, sustainability, and clinical outcomes of telehealth videoconferencing	Video consultation with specific telehealth software at home or at a nearest healthcare facility Both transplant (n = 32) and nontransplant chronic kidney disease patients (n = 32)	Uptake at y 1 was 71%, declined significantly to 50% in y 2 No significant differences in creatinine, BP, mortality, or hospitalization were observed between groups Great reduction in travel distance (–48% in y 1, –37% in y 2)	Decrease in uptake between y 1 and 2 Reasons uncertain, but probably divers This was not explored in the study Reimbursement and regulation remain central to the uptake and acceptance
Gonzales et al15	2021	136	Medication adherence and safety	Randomized, controlled trial for 12 mo, with use of mobile health-based application vs traditional care	Smartphone-enabled mobile health app (custom-made) with automatically updated medication list, reminders, and automated messages for missed doses, side-effect tracking, and home-based BP and glucose monitoring	Lower risk of medication errors (RR 0.39; 95% CI, 0.28-0.55), grade 3 adverse events (RR 0.55; 95% CI, 0.30-0.99), and rate of hospitalization (RR 0.46; 95% CI, 0.27-0.77)	Intensive pharmacist-led medication therapy monitoring instead of self-monitoring Limited inclusivity (of the 774 eligible patients, only 136 were randomly assigned)
Melilli et al26	2021	90	Medication adherence	Prospective, observational, multicenter, 2-phase pilot study in kidney and liver transplant recipients	TYM, a novel mHealth technology with a Quick Response code-scan app	68% used TYM regularly. 6-mo total correct intakes ranged between 69% and 76%, 12%–19% intakes were out-of-time, and 9%–12% were missed At 1 y, 53 (59%) patients were still active users of TYM	Limited eligibility of 90 of 204 patients mostly because of not owning smartphone/using apps Laborious for patients and healthcare provider No control group

BAASIS, Basel Assessment of Adherence to Immunosuppressive Medication Scale; BP, blood pressure; CI, confidence interval; OR, odds ratio; PC, personal computer; RR, risk ratio; TYM, TrackYourMed; VAS, visual analog scale.