Hybrid care model in kidney transplantation: a safe strategy in times of pandemic

ABSTRACT Introduction: The COVID-19 pandemic required rapid changes in hospital workflows. Telemedicine care models have become fundamental tools in this scenario, reducing the movement of individuals and the risk of COVID-19 transmission. However, there is a lack of equivalence studies on telemedicine regarding relevant clinical outcomes in kidney transplant patients. This study aims to evaluate the equivalence of the hybrid model of outpatient care for kidney transplant patients compared with the standard in-person model in terms of the number of hospitalizations, loss of graft function, and deaths over a one-year follow-up. Methods: We conducted a retrospective cohort study of kidney transplant recipients, over the age of 18, with a functioning graft, receiving immunosuppressive therapy for one to ten years at a tertiary hospital in southern Brazil, allocated to the in-person group (April 2016) or the hybrid group (April 2020), employing two one-sided tests (TOST) and equivalence testing to compare hospitalization rates, graft survival, and mortality. The follow-up duration was one year. Data were extracted from electronic and physical medical records. Results: The study comprised 194 patients (56.7% male, median age 54 years). Variables analyzed included demographic, laboratory, and clinical data. Transplant times were different between groups: 3.6 ± 2.50 years (in-person) vs. 4.3 ± 2.35 years (hybrid model) (p = 0.049). Equivalence was found in hospitalization rates (p = 0.038), graft survival (p = 0.0359), and mortality (p = 0.007) between care models. Conclusion: Hybrid care for kidney transplant patients has shown equivalence to in-person visits concerning critical clinical outcomes during the pandemic. This suggests its viability as a permanent care model. Further studies are warranted to reinforce these findings and examine long-term implications.