Evaluating a nurse-coordinated hybrid telehealth for stable post-kidney transplant care.

BACKGROUND

Integrating telemedicine into post-kidney transplant (KT) care is constrained by the need for complex diagnostic monitoring. Turnaround times for immunosuppressive trough levels and viral assays often render same-day virtual visits clinically incomplete.

OBJECTIVES

To evaluate the clinical safety, logistical impact, and patient-reported outcomes of a nurse-coordinated hybrid tele-clinic for stable post-KT recipients.

DESIGN

Prospective cohort study conducted between January and December 2025.

PARTICIPANTS

Fifty stable post-KT recipients (≥1 year post-transplant, serum creatinine <2.0 mg/dL) at King Chulalongkorn Memorial Hospital, Bangkok, Thailand.

MEASUREMENTS: The two-step model decoupled the clinical encounter: an accelerated nurse-led in-person visit (phlebotomy, medication dispensing, triage) on Monday, followed by a physician-led video consultation on Tuesday once all results were finalized. Primary outcomes were quality of life (WHOQOL-BREF-THAI) and patient satisfaction at one year. Secondary outcomes included allograft function, immunosuppressive drug levels, complication rates, visit time, and out-of-pocket expenses.

RESULTS

Allograft function and immunosuppressive concentrations remained stable at one year. Complications were rare (one acute rejection, one urinary tract infection). Visit time was reduced by 50% (12.0 to 6.0 h; p < 0.001) and out-of-pocket expenses decreased significantly (p < 0.001). Overall quality of life improved (60.00 vs 61.89; p = 0.011), driven by physical and psychological domains. Patient satisfaction improved across all ten measured dimensions (p < 0.001).

CONCLUSIONS

A nurse-coordinated, two-step hybrid tele-clinic is a safe and effective alternative to traditional post-KT care, reducing patient burden and improving quality of life without compromising clinical outcomes.