Expanding Remote Patient Monitoring for Pre-Lung Transplant Candidates With Interstitial Lung Disease

IF 1.8 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2026-08-27 DOI:10.1111/ctr.70657

Lisa Wickerson, Tamires De Mori, Noori Chowdhury, Cecilia Chaparro, Nikki Marks, Shaf Keshavjee, Aman Sidhu

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Abstract

Introduction

Interstitial lung disease (ILD) is a primary indication for lung transplantation (LTx). Close monitoring of disease progression informs transplant urgency, timing, medical and pre-habilitation management, and remote home monitoring may support frequent assessment of clinical status and response to interventions.

Methods

LTx candidates with ILD received a home spirometer, pulse oximeter, and activity tracker. Participants manually entered data weekly and completed the King's Brief ILD questionnaire (KBILD) monthly within a patient portal linked to the electronic medical record (EMR).

Results

Of 63 people approached at the start of outpatient pre-habilitation, 50 (79%) enrolled for additional remote monitoring and 40 (80%) entered data for ≥4 weeks. Reporting adherence was higher for pulse oximetry (82%) and spirometry (69%) than daily steps tracking (31%). During a median LTx waiting period of 11 [4–18] weeks, there were no changes in home spirometry or self-reported health status; however, daily step count decreased (mean 5639 ± 3989–4653 ± 3303; p = 0.04, n = 25). Wait list status for transplant urgency was increased during the study period in 40% of participants. Fraction of inspired oxygen (FiO₂) for exertion increased (median 0.49 [0.17]–0.51 [0.16]; p = 0.01), with no clinically significant hypoxemia reported after aerobic exercise. For 20 participants using a treadmill for both on-site and home exercise, median on-site walking distance was maintained (912 [469]–966 [497] m; p = 0.64), whereas home-based walking distance declined (1073 [831]–1019 [409] m, p = 0.02).

Conclusion

Remote monitoring in LTx candidates with ILD was feasible, with data integrated into the EMR for clinicians to view. This can provide multimodal data to inform clinical status changes and interventions. Future plans include direct device (Wi-Fi, Bluetooth) integration of monitoring tools into the EMR to increase reporting and decrease manual entry errors, and building escalation alerts for changes in spirometry, oximetry, and activity.

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扩大对肺移植前肺间质性疾病候选者的远程监测

间质性肺疾病（ILD）是肺移植（LTx）的主要适应症。密切监测疾病进展，告知移植的紧迫性、时机、医疗和康复前管理，远程家庭监测可以支持频繁评估临床状况和对干预措施的反应。方法LTx患者接受肺活量计、脉搏血氧仪和活动追踪仪。参与者每周手动输入数据，每月在与电子病历（EMR）相连的患者门户网站中完成King’s Brief ILD问卷（KBILD）。结果在门诊预康复开始时接触的63人中，50人（79%）参加了额外的远程监测，40人（80%）输入了≥4周的数据。脉搏血氧仪（82%）和肺活量仪（69%）的依从性高于每日步数追踪（31%）。在LTx的中位等待期为11[4-18]周期间，家庭肺活量测定或自我报告的健康状况没有变化；然而，每日步数减少（平均5639±3989-4653±3303；p = 0.04, n = 25）。在研究期间，40%的参与者的移植紧急等待名单状态增加。运动时吸入氧（FiO2）分数增加（中位数0.49 [0.17]-0.51 [0.16];p = 0.01），有氧运动后无明显临床低氧血症报告。对于20名同时使用跑步机进行现场和家庭锻炼的参与者，现场步行距离的中位数保持在912 [469]-966 [497]m， p = 0.64)，而家庭步行距离则下降了（1073 [831]-1019 [409]m, p = 0.02）。结论远程监测LTx合并ILD患者是可行的，并将数据整合到EMR中供临床医生查看。这可以提供多模式数据，以告知临床状态变化和干预措施。未来的计划包括将直接设备（Wi-Fi、蓝牙）监控工具集成到EMR中，以增加报告并减少人工输入错误，并为肺活量、血氧饱和度和活动的变化构建升级警报。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.