#2096 A randomized controlled study of telemonitoring in kidney transplantation: interim results of the Ap'TX trial

Abstract Background and Aims Telemedicine is a matter of growing interest in transplantation. However, its real added value is uncertain. In 2018, we have started to study the medico-economic impact of a less stringent on-site follow-up of our kidney transplant recipients (KTR) using Ap'Telecare®. We present here a preliminary report focusing on 500 KTR with a 2 years follow-up. Method The Ap'Tx study (NCT03750331) is a controlled randomized trial testing the hypothesis that monitoring stable KTR (at least 3 months after transplantation) with Ap'Telecare® is non inferior to a conventional follow-up in terms of the occurrence of graft dysfunction (defined as a decrease in eGFR of 20% or more). On-site consultation scheduling was 2 times less frequent for KTR followed by Ap'Telecare®. Secondary endpoints were the impact of a remote follow-up by Ap'Telecare® on medical workload, economic saving and quality of life. Results 688 KTR have been randomized so far with 500 of them having completed the 2 years follow-up. Among all KTR approached to participate in the study, 37% were not included mainly due to difficulties with accessing internet (44%) or to masterize the app (36%). After randomization, 27% of KTR were considered as non compliant in adequately using Ap'Telecare®. Over the 2 years study duration, graft dysfunction occurred in 16% and 18% of KTR in the Ap'telecare® and conventional arm, respectively (RR of 0.87 (0.56; 1.39), non-inferiority confirmed, superiority not significant). Medical time dedicated to handling daily lab results was decreased by a factor 3 for KTR using Ap'Telecare®. Rates of unplanned consultations and hospitalisations were reduced by 26% and 32% for patients using Ap'Telecare®, respectively (P < .05). Conclusion This preliminary report of Ap'Tx suggest that a partial and reasonable remote follow-up of selected KTR is feasible, safe and logistically beneficial. Determining the nature of factors associated with a wider implementation of Ap'Telecare® is underway.