A Mission Toward Early Detection of Lung Transplant Rejection: The UCSF Health Virtual Lung Transplant Care Program

Chronic rejection remains the main obstacle to long term survival for people who have had lung transplant, and they often express anxiety about the seemingly ever-present risk of this insidious and often progressive complication. Unfortunately, screening for chronic rejection requires frequent testing – spirometry – which has typically been done in hospital-based pulmonary function laboratories. Thus, early detection of chronic rejection is challenging and inconvenient because it requires time, travel, and cost, limiting the frequency of traditional screening to only a few times a year. This has become especially relevant as we have new therapies to treat chronic rejection that are more likely to be most successful when administered early in the disease process. For years, we have explored ways to provide home spirometry to enable more frequent screening. At first, the technology was not widely available or reliable. Then, as the device technology emerged, we realized that simply giving patients home spirometry devices and asking them to self-monitor was not going to be successful. Patients struggled with uncertainty and some stopped using the devices because our team could not give and receive feedback. We lacked a method to reliably engage our patients in home monitoring. For the past several years, our team was not able to overcome this barrier.

Today, we are excited about the development and launch of a new home-spirometry program for the UCSF Health Lung Transplant program. This program, developed as part of UCSF Health’s Digital Patient Experience program, weaves together a home spirometry device with a conversational chatbot tool from Conversa Health to engage patients and elicit symptoms. This platform allows the Lung Transplant team to remotely track patients with the goal of identifying both symptomatic and, even more importantly, asymptomatic changes in lung function that may be the first sign of early chronic rejection. Our long-term vision is to build on this platform to provide a comprehensive health monitoring program to empower patients to understand and track other health metrics that are important for good transplant outcomes including medication adherence, lab monitoring, exercise, and nutrition. Ultimately, we hope that by providing these tools we will help our patients develop more self-care agency and feel more in control of their health.

— By Drs. Steve Hays and Jonathan Singer