Kidney transplant (KT) recipients living in areas distant from transplant centers face more challenges in maintaining adequate follow-up due to long travel distances, greater costs, and increased work absence for travelling. The Iowa City VA KT program established a telehealth (TH) transplant clinic in 2012 with the San Juan (P.R.) VA in order to facilitate long-term kidney transplant follow-up for residents of P.R. who had a KT for 2 or more years.

Methods: All KT recipients from our center that reside in P.R. who were followed in the TH transplant clinic were studied. Parameters analyzed to compare before/after initiation of TH included: Renal function, tacrolimus levels, proteinuria, acute rejection episodes (AR), blood pressure, adherence with lab and clinic visits.

Results: 33 patients underwent 53 TH visits. Time between KT and first TH follow-up was 62±32 months, and duration of TH follow-up was 18±7 months. The serum creatinine, urinary protein, BP, and tacrolimus levels before and after enrollment in TH are presented in table 1. Three patients had 1 episode each of biopsy-proven AR before TH. No new episodes of AR were observed after TH implementation. Estimated savings in travel costs for the 53 visits was $121,900.00, 1484 hours of travel time or 426.240 miles, and 318 days of work absence.

Conclusions: Kidney transplant TH clinic is a viable option for long-term follow-up of KT recipients living in rural areas, facilitating access to follow-up without affecting stability of allograft function, adherence with lab and clinic visits, and rejection rates in selected stable KT recipients. It provides substantial cost savings and minimizes work absence by reducing the need for long-distance travel. Expansion of kidney transplant TH should be considered as an economical and safe alternative for stable KT recipients and has the potential to improve access to transplant centers for KT recipients who may live remote from these VA tertiary care facilities.

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