Background: With widespread adoption of EHR (electronic health record), patients have access to a patient portal where they can view and thereby help monitor their lab results. Because kidney transplant outcomes are so dependent on close monitoring of lab work and patient engagement in care, we strive for full enrollment. We hypothesized that certain patients would be more likely to utilize this function and may derive more benefit from its usage. Generally, higher risk patients are followed even more closely by transplant center staff, and so focus was concentrated on the non-high risk subset. For this purpose, high risk is defined as patients who were at higher immunological risk and received thymoglobulin induction.

Methods: All patients were invited to subscribe to the patient portal at the time of transplant and at outpatient post-transplant encounters. We performed a review of a single center's kidney transplants between March 2015 (implementation date of Epic EHR) and May 2017 with a minimum 3 month follow up post-transplant. Generalized linear models and Kaplan-Meier survival estimation were used to test hypotheses specified a priori based on clinical experience.

Results: One hundred ten adult kidney transplants were performed, with 39 patients (35%) enrolled in the patient portal. There were trends toward higher enrollment based on male gender, younger age, higher education level and Caucasian race. Rates of biopsy, readmission within 1 year, 90 day creatinine and 1 year creatinine were not significantly different between enrolled & non-enrolled patients. Subsequently, the 26 high risk patients who received thymoglobulin induction were excluded. Of the remaining 84, for those who required a biopsy, readmission was more likely in non-enrolled than in enrolled patients (raw p=0.0137, adjusted p=0.0655). All graft loss and patient death in this non-high risk subset occurred in non-enrolled patients (4/55 vs 0/29 enrolled).

Conclusions: Patient engagement through EHR portal may have greater utility in patients with moderate risk profiles, lending toward lower clinician monitoring but with high enough risk to realize benefit.

CITATION INFORMATION: Osband A., Machan J., Morrissey P. Benefit of Patient Portal Usage in Non-High Risk Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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