Use of an Automated Clinical Management System Improves Outpatient Immunosuppressive Care Following Liver Transplantation

Overview

Journal J Am Med Inform Assoc

Publisher Oxford University Press

Specialty Medical Informatics

Date 2010 Jul 3

PMID 20595306

Citations 6

Authors

Esther S Park

Marie R Peccoud

Kay A Wicks

Jeffrey B Halldorson

Robert L Carithers Jr

Jorge D Reyes

James D Perkins

Affiliations

Soon will be listed here.

Abstract

Objective: Immunosuppressive therapy following transplantation, if not managed well, can lead to increased drug toxicity or rejection episodes. We investigated whether use of an automated clinical management system in our liver transplant program would improve clinical outcomes in managing transplant recipients' immunosuppressive medications.

Design: We performed a retrospective cohort study of two patient groups receiving liver transplants at our institution. One group of 301 patients transplanted from January 1, 2004 to November 30, 2006 received outpatient immunosuppressive management using a paper charting system. After instituting an automated clinical management system, the following group of 127 patients transplanted from December 12, 2006 to April 1, 2008 received their outpatient immunosuppressive management with that system. Only patients who received tacrolimus therapy, with or without mycophenolate mofetil or prednisone, were studied.

Measurements: Our endpoints included percentage of patients having rejection and/or tacrolimus toxicity episodes. Various recipient, intraoperative, donor, and postoperative variables, including managing the immunosuppressive therapy with a paper charting system or an automated management system, were studied to determine which factors were associated with our endpoints.

Results: Multivariable logistic regression analysis showed the automated system was significantly associated with fewer rejection episodes and fewer tacrolimus toxicity events. Formal cost-effectiveness analysis of the nurses' salaries for 1 year showed the automated system cost US$197 per patient and the paper system cost US$1703 per patient. The automated system improved quality of life years.

Conclusion: Use of an automated clinical management system for outpatient immunosuppressive management for liver transplant patients has resulted in a decrease in both tacrolimus toxicity and rejection episodes and is cost-effective.

Citing Articles

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

Koc O, Pierco M, Remans K, Van den Hende T, Verbeek J, van Malenstein H Clin Transplant. 2021; 36(1):e14494.

PMID: 34596918 PMC: 9285405. DOI: 10.1111/ctr.14494.

Translation of evidence into kidney transplant clinical practice: managing drug-lab interactions by a context-aware clinical decision support system.

Niazkhani Z, Fereidoni M, Khazaee P, Shiva A, Makhdoomi K, Georgiou A BMC Med Inform Decis Mak. 2020; 20(1):196.

PMID: 32819359 PMC: 7439664. DOI: 10.1186/s12911-020-01196-w.

Feasibility of Using High-Contrast Grating as a Point-of-Care Sensor for Therapeutic Drug Monitoring of Immunosuppressants.

Liu Y, Thantrakul C, Kan S, Chang-Hasnain C, Ho D IEEE J Transl Eng Health Med. 2020; 8:2800206.

PMID: 32296617 PMC: 7156223. DOI: 10.1109/JTEHM.2020.2966478.

Adherence to immunosuppressive therapy following liver transplantation: an integrative review.

Oliveira R, Turrini R, Poveda V Rev Lat Am Enfermagem. 2016; 24:e2778.

PMID: 27579933 PMC: 5016054. DOI: 10.1590/1518-8345.1072.2778.

Longitudinal Analysis of Computerized Alerts for Laboratory Monitoring of Post-liver Transplant Immunosuppressive Care.

Jacobs J, Narus S, Evans R, Staes C AMIA Annu Symp Proc. 2016; 2015:1918-26.

PMID: 26958291 PMC: 4765651.

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