Integrated care management model for liver transplantation: a narrative review and single-center implementation experience

Introduction

Over the past two decades, liver transplantation (LT) has been widely recognized as the most effective treatment for effective end-stage liver disease (ESLD). Continuous advancements in medical research and technological development have significantly refined surgical techniques and improved patient survival rates. However, organ shortages remain a critical issue. The increasing number of patients on LT waiting lists, coupled with unstandardized preoperative management, has led to numerous patients failing to receive timely transplants, ultimately resulting in mortality (1). Even among those who successfully undergo LT, postoperative complications, inconsistent medication adherence, and inadequate management are commonly encountered, leading to decreased survival rates and less favorable clinical outcomes.

Integrated Care Management (ICM) throughout the LT process is considered a significant factor in improving the prognosis of transplant recipients. Long-term health management strategies have demonstrated potential to enhance the quality of life and promote recovery (2). This narrative review summarizes the challenges in LT management and presents an ICM derived from a single-center implementation experience. We present this article in accordance with the Narrative Review reporting checklist (available at https://tgh.amegroups.com/article/view/10.21037/tgh-25-66/rc).

Methods

An extensive electronic literature search was performed using PubMed database to identify relevant articles. The search included prospective clinical trials, observational trials, case-control studies, systematic reviews with or without meta-analysis. Articles were limited to English and Chinese language publications. The following Medical Subject Headings (MeSH) terms and free-text keywords were combined with Boolean operators: (“liver transplantation” OR “liver transplant*” OR “orthotopic liver transplantation” OR “OLT”) AND (“postoperative management” OR “whole-course management” OR “perioperative care” OR “long-term follow-up”) AND (“immunosuppress*” OR “tacrolimus” OR “cyclosporine” OR “mycophenolate” OR “infection prophylaxis” OR “graft function” OR “rejection” OR “biliary stricture” OR “hepatic artery thrombosis” OR “renal dysfunction” OR “hepatitis B recurrence” OR “hepatitis C recurrence”) (Table 1).

Results

Challenges in LT management

Previous management models (Figure 1)

Figure 1 Previous management model of liver transplantation.

Since Starzl conducted the first successful LT in 1963, significant improvements have been observed in the survival rates of transplant recipients (3). By 2021, more than 34,694 individuals worldwide had undergone LT (4). In China, the initial LT procedure was performed in 1977 (5). Technological advancements have subsequently established China as the second-largest country globally in terms of LT volume. According to data from the China Liver Transplant Registry (CLTR), between 2018 and 2020, approximately 6,000 LTs were performed annually in China (6). The post-transplant survival rate in China, reaching 68.9%, has been comparable to that of developed countries in both volume and quality (7).

Significant progress in LT surgery, organ perfusion techniques, perioperative management, critical care medicine, and immunosuppressive therapy has contributed to notable improvements in 5-year survival rates following transplantation. However, long-term survival rates have not demonstrated parallel advancements, primarily due to inadequate mid- and long-term postoperative health management (8). Consequently, clinical priorities have shifted from merely reducing mortality to improving long-term quality of life, minimizing complications, and preventing disease recurrence. Although the necessity of mid and long-term health management for transplant patients has been acknowledged, comprehensive guidelines and strategies for postoperative care remain insufficient (9).

The Chinese healthcare context for LT

Significant disparities between the healthcare systems of developing and developed countries are particularly evident in the field of LT in China. As the nation with the second highest volume of LT procedures globally, China demonstrates a marked regional imbalance in the allocation of transplant-related medical resources. According to the 2023 China Organ Transplant Development Report, 46.6% of the 87 certified LT centers are concentrated in the eastern region, which accounts for only 35% of the national population but performs 56.6% of all transplant procedures (10). In contrast, patients from the western and northeastern regions must travel a median distance of 800 kilometers to access specialized LT services. This geographical disparity, exacerbated by structural limitations within the hierarchical diagnosis and treatment system, poses significant challenges to equitable access and long-term management of LT care in China (11). In comparison, the United States has implemented the United Network for Organ Sharing (UNOS) system, which allocates organs across 11 regions and achieves a mean treatment distance approximately one-quarter that of China’s, thereby facilitating more localized access to transplantation services (12).

In response to these challenges, China has designated “5G-enabled healthcare” as a strategic priority in its 14th Five-Year Plan. By 2023, 89% of hospitals had established internet-based medical platforms, as reported by the National Health Commission (13). The rapid expansion of digital infrastructure presents new opportunities to mitigate geographic barriers and highlights the need for an integrated, continuous LT management model adapted to the national healthcare context. In contrast, high-income countries with more decentralized transplant networks tend to facilitate more consistent long-term follow-up and coordinated care across regions.

Challenges in the management of liver transplant recipients

Despite advancements in LT techniques, substantial challenges remain in the management of LT recipients. These challenges are as follows:

Lack of ICM

The absence of ICM has led to suboptimal long-term outcomes for many LT recipients. A significant number of patients failed to attend regular outpatient follow-ups at designated transplant centers, resulting in a loss of long-term monitoring. This issue is closely associated with severe complications, including organ rejection, allograft failure, infection, renal failure, metabolic disorders, and malignancies (14).

Insufficient medical resources

The increasing number of LT recipients has placed considerable strain on liver transplant centers. Overcrowding in follow-up clinics has limited the time available for effective doctor-patient communication (15). Additionally, liver transplant centers in China are concentrated in a few cities, leaving other regions underserved by experienced medical professionals. This geographic imbalance necessitates long-distance travel for many patients to access specialized care, resulting in significant financial and logistical burdens (16).

Absence of intelligent management systems

The lack of an intelligent management system has hindered the collection and analysis of real-world data. In the absence of standardized databases and information technology support, crucial insights into patient outcomes and quality improvement efforts have been limited (17). This deficiency has also impeded scientific research and the development of evidence-based practices (18).

Limited multidisciplinary collaboration

LT recipients require comprehensive care due to the complexity of their medical needs. Effective management necessitates the involvement of a multidisciplinary medical team, including specialists in preoperative evaluation, immunosuppressant management, nutritional support, psychological counseling, and rehabilitation. However, the lack of a structured interdisciplinary framework often requires patients to navigate multiple departments, diminishing the efficiency and continuity of care (19).

Inadequate humanistic care

The successful reintegration of liver transplant recipients into society and the workforce is essential for their psychological well-being and overall recovery. However, many patients face significant barriers in returning to work due to insufficient professional guidance. This gap delays reintegration, exacerbating feelings of anxiety and depression (20).

Outcome

Although the 5-year survival rate following LT has improved, the absence of ICM has led to several challenges, including stagnation in long-term survival rates, low patient satisfaction, and a high incidence of adverse effects. ICM is crucial for LT recipients to maintain graft function, protect patient health, and enable the early detection and management of complications.

As the number of LT recipients continues to increase, liver transplant centers are increasingly burdened with postoperative care. Many patients reside at considerable distances from these centers, complicating the effective management of postoperative complications by local hospitals. Frequent visits to transplant centers impose significant economic and logistical burdens on patients, often intensifying their anxiety. Furthermore, there is a notable absence of comprehensive strategies for the health management of LT recipients, particularly in China, where research on postoperative care for these patients is virtually nonexistent (16). Consequently, the development of a novel health management model specifically tailored to the needs of LT recipients is imperative.

Establishment of an ICM model for LT

The Liver Transplantation Center at West China Hospital, Sichuan University has been actively exploring strategies to improve LT survival rates and enhance the long-term quality of life for patients. The center’s LT survival rates are reported to be comparable to international standards (21). Based on accumulated experience, the center recognizes the essential role of comprehensive, multidisciplinary postoperative management. To this end, an ICM model has been developed, supported by a multidisciplinary diagnosis and treatment team, artificial intelligence (AI), and an intelligent information platform. This model integrates multidisciplinary care, AI, telemedicine, and intelligent information systems to ensure continuous management for LT recipients (Figure 2).

Figure 2 Work of management physicians in integrated care management of liver transplantation.

Multidisciplinary treatment (MDT)

The Liver Transplantation Center organizes an MDT, where a full-time management physician (MP) is assigned to coordinate clinical workflow and patient care. The team includes LT specialists, nursing staff, and experts from various multidisciplinary fields. This dedicated team operates with fixed personnel, clearly defined roles, and efficient referral pathways (Figure 3).

Figure 3 MDT work in integrated care management of liver transplantation. MDT, multidisciplinary treatment.

Work of the MPs

MPs play a critical role in the care of LT recipients, being closely involved in all phases of diagnosis and treatment. They act as primary care providers, responsible for patient management and for communicating with both patients and the MDT. Before transplantation, MPs collaborate with the liver transplant center team during patient visits. Patients on the transplant waiting list may receive care across various departments, with MPs actively participating in internal medicine rounds. After transplantation, MPs continue to work with the transplant team during patient visits. Before discharge, a comprehensive LT management file is created, documenting the patient’s primary diagnosis, surgical procedure, and key medical information. MP also provides the patient with guidance on post-transplant outpatient follow-up and relevant medical knowledge. Additionally, the MP explains how to use the West China Hospital Internet App, allowing the patient to remain in contact with the MDT remotely after discharge (Figure 4).

Figure 4 Contents of integrated care management of liver transplantation.

Contents of the ICM of LT (Figure 5)

Figure 5 The landscape of integrated care management of liver transplantation in West China Hospital. MDT, multidisciplinary treatment.

• Patient enrollment: before participating in the ICM of LT, recipients are required to sign an informed consent form. The MP then explains the ICM service and establishes an electronic medical record for the patient.
• Formulating an outpatient follow-up plan: the MDTs develop a personalized outpatient follow-up plan for each patient.
• Follow-up management: before each follow-up, the recipient receives a reminder via text message and phone call from the liver transplant center. The MP schedules the follow-up clinic visit and appointments for necessary tests, such as blood tests and Doppler ultrasound examinations. After completing the required tests, the patient first consults the MP, who reviews the patient’s examination results and conducts a comprehensive evaluation. This evaluation includes measurements of height, weight, blood pressure, blood sugar, blood lipids, blood drug concentration, liver function, kidney function, tumor markers, psychological state, nutritional status, pain, medication history, clinical symptoms, and a thorough medical history. MP also provides necessary medical consultations for the LT recipient.
• Outpatient follow-up: LT recipients participate in follow-up care provided by the MDT, which offers tailored medical advice based on the recipient’s specific condition. Recommendations may include guidance on medication, nutrition, blood sugar management, blood pressure management, and rehabilitation exercises.
• Telemedicine: outpatient visits have a limited scope, and LT recipients may experience unforeseen health issues after discharge. Certain treatments can be managed by local hospitals, while others may require remote communication with the liver transplant center team to adjust the treatment plan promptly. Patients can upload test results to the treatment team for remote follow-up consultations. Telemedicine consultations can be requested, and the team may prescribe immunosuppressants remotely. Even patients residing in distant locations, such as the northeast of China, can receive timely medical advice from the transplant team, with medications delivered to their homes.
• Disease education: personalized disease education plans are developed for patients and delivered through an Internet application. These plans may include videos, pictures, articles, and educational animations, providing regular updates on disease management, nutritional guidance, rehabilitation exercises, and standardized medication practices.

The significance of the ICM model for liver transplant recipients

MDTs

MDT’s model has emerged as a collaborative approach to diagnosis and treatment. Research in the United States has demonstrated that MDTs enhance clinical decision-making efficiency, improve patient satisfaction, and positively influence patient outcomes (22). Furthermore, MDTs play an essential role in comprehensive patient management. The European Partnership for Action Against Cancer (EPAAC) advocates for the inclusion of MDTs in all cancer treatments (23). In contrast, in China, multidisciplinary diagnosis and treatment are still in the early stages of development, and comprehensive health management throughout the disease lifecycle remains particularly uncommon (24).

MDT team specialists contribute their extensive experience in diagnosis and treatment, alongside strong decision-making capabilities, to collaboratively design customized treatment plans for recipients. MP coordinates these efforts to ensure standardized and efficient operations. This many-to-one treatment model enhances both the quality and efficiency of medical care (25). By offering holistic health management, the MDT approach overcomes the limitations of single-disciplinary perspectives, improves recipients’ quality of life and satisfaction, and potentially enhances long-term prognosis (19).

Telemedicine

Telemedicine offers numerous advantages. During the coronavirus disease 2019 (COVID-19) pandemic, telemedicine proved particularly vital, further demonstrating its value in healthcare delivery (26,27).

It is a vital tool for promoting the equitable distribution of medical resources, optimizing clinical management, and delivering superior care to LT recipients. Key advantages include:

Expanded accessibility of medical resources

Telemedicine helps mitigate the challenges posed by the unequal distribution of medical resources, enabling patients to access high-quality care regardless of their location (28). This technology ensures that patients in remote areas or underserved regions can benefit from equitable and consistent medical services (29).

Reduced patient burden

By eliminating spatial and temporal barriers, telemedicine broadens the reach of healthcare services and enhances their accessibility (30). Patients can access care without traveling, thereby reducing the time and financial burdens associated with in-person visits. This approach improves the overall efficiency and quality of medical treatment while shortening the total treatment duration (31). Through telemedicine, even patients in remote areas can consult with specialized LT teams in real-time.

Comprehensive management across the care continuum

Telemedicine enables physicians to provide individualized, full-process management for multiple patients remotely. This holistic approach enhances the completeness and effectiveness of diagnosis and treatment plans, especially for LT recipients.

Advancements in medical informatization

Telemedicine supports the intelligent collection, storage, and analysis of medical data. Efficient data management facilitates the rapid retrieval and updating of patient information, improving diagnostic and treatment outcomes. Additionally, it contributes to the growth and development of medical disciplines by leveraging data insights to refine clinical practices.

Management based on AI

In traditional models, the management of LT recipients relies heavily on the medical staff at the transplant center, which presents several limitations. This approach also struggles to integrate various aspects of patient care, such as diagnosis, treatment, disease management, and health education, making it difficult to provide personalized, comprehensive health services (31). Furthermore, once patients are discharged, it becomes challenging for medical staff to manage their long-term health due to substantial workloads, increasing both working hours and staff burdens. However, with advancements in AI, comprehensive management of LT recipients has become more feasible. By leveraging technologies such as AI, the Internet of Things, and telemedicine, health management can be integrated with information technology. This integration enhances management efficiency and effectiveness, augments the capacity of medical staff to oversee patient care, and ultimately reduces their workload (32).

The AI-supported platform automatically generates an outpatient follow-up plan for each recipient based on pre-established plans developed by the MDT. It reminds patients to schedule appointments before each follow-up visit and facilitates the booking of necessary examinations and outpatient consultations. Before the follow-up, the platform automatically collects the patient’s test and examination results into the electronic medical record system, generating a trend chart. Additionally, the platform triggers alerts for critical values, which are simultaneously sent to both the patient and medical staff. Furthermore, when patients are discharged and return home, they can actively engage in the entire management process through a mobile app. The app allows patients to monitor their health status, record their diet, exercise, medication, psychological state, and other behaviors, as well as communicate in real-time with the MDTs

Patient education

Studies have indicated that LT recipients who actively engage with transplant-related knowledge before and after the procedure exhibit lower readmission rates compared to those who neglect such knowledge (33-35). Patient education is crucial for LT recipients, although many patients lack sufficient education, particularly regarding essential aspects of post-transplant care. Effective patient education is integral to the management process of LT, encompassing pre-transplant, post-transplant, and lifelong self-management topics. MPs will identify common patient inquiries and collaborate with multidisciplinary experts to produce a series of educational videos. These videos will be tailored to the individual patient’s needs and current health status through an AI-supported platform, delivering personalized content. This approach ensures patients receive accurate health information, encourages healthier lifestyle choices, and enhances their ability to manage their health, thereby improving their health literacy.

Mental state management

The psychological well-being of LT recipients is influenced by factors such as prolonged use of immunosuppressants, postoperative complications, high medical expenses, and the necessity for regular outpatient follow-ups (36-42). Research has shown that most LT recipients experience psychological distress, with anxiety being particularly prevalent (43). These individuals often face anxiety and depression, which can persist for extended periods. Studies suggest that patients with strong self-management skills, a comprehensive understanding of their condition, and access to psychological support exhibit better mental health outcomes (44). Therefore, psychological assessment and support from the LT management team are essential in fostering patients’ confidence in managing their condition and mitigating anxiety and depression. The comprehensive LT management model includes the establishment of a mental health intervention team, which closely monitors recipients’ psychological states. During outpatient follow-ups, patients undergo psychological assessments, and if signs of psychological distress, such as anxiety or depression, are identified, psychological experts from the MDT intervene promptly, offering counseling to help patients build confidence and reintegrate socially. In the initial stages, the focus is on managing pain, sleep disorders, and anxiety, while long-term care is centered on rebuilding social relationships and facilitating patients’ return to the workforce.

Discussion

Although the single-center pilot project conducted at West China Hospital has preliminarily demonstrated the feasibility of a whole-process management model for LT, its large-scale implementation continues to face four major challenges: limited patient digital literacy, disparities in infrastructure, increased clinical workload, and unresolved ethical concerns. First, limited proficiency in the use of smart devices and digital platforms among elderly and rural populations may directly compromise adherence to remote follow-up protocols. Second, the uneven distribution of 5G and broadband infrastructure in western regions can result in delays during video consultations, reduced image resolution, or even service interruptions, thereby diminishing the accessibility and reliability of care. Third, the additional workload associated with online follow-up, data review, and AI-based early warning systems may substantially increase the burden on frontline medical staff in the absence of corresponding performance-based compensation mechanisms. Finally, the use of AI-assisted management requires clear delineation of responsibility for adverse outcomes arising from algorithmic errors, and patients must be fully informed and provide consent for the use of their data. Moreover, the urban and younger population bias inherent in training datasets may exacerbate algorithmic disparities affecting vulnerable groups. This issue urgently necessitates correction through the incorporation of multicenter, multilingual datasets and rigorous external validation. Given that the present study is a narrative review, the proposed model has not yet been prospectively validated, and data on patient-level effectiveness, satisfaction, and cost-efficiency remain unavailable. To address this gap, a prospective pilot cohort study (n=200; registration number ChiCTR2400080724) has been initiated to assess the model’s impact on 1-year graft survival, patient-reported quality of life, and incremental cost-effectiveness compared with standard care. The results will be reported separately and are expected to provide an evidence-based foundation for the further refinement and broader dissemination of this model.

Conclusions

Although LT surgery has been improving, long-term survival rates have not improved significantly. Several factors contribute to this plateau, but fragmented post-transplant care—particularly in the Chinese setting, where systematic, long-term management protocols remain scarce—stands out as a potentially modifiable driver.

This narrative review was undertaken to synthesise current shortcomings in post-transplant care and to outline the ICM model developed at West China Hospital. The model combines four elements: (I) an MDT coordinated by a full-time MP; (II) an AI-supported, cloud-based information platform; (III) telemedicine encounters; and (IV) patient education with embedded psychological support. This model is expected to provide systematic and continuous management services for patients in different regions, and is expected to improve diagnosis and treatment efficiency, enhance care quality, and improve survival outcomes in the long term. The description derives from a single-centre implementation experience; no comparative effectiveness or cost data are yet available. Its real-world impact on graft survival and quality of life, and its net economic effect, remain open. In conclusion, ICM represents a promising direction for improving long-term results after LT, but rigorous, multi-centre validation is required before any claims of improved survival or cost neutrality can be sustained.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://tgh.amegroups.com/article/view/10.21037/tgh-25-66/rc

Peer Review File: Available at https://tgh.amegroups.com/article/view/10.21037/tgh-25-66/prf

Funding: We acknowledge the support from the Natural Science Foundation of China Youth Program (grant No. 82303220).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tgh.amegroups.com/article/view/10.21037/tgh-25-66/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Feng S, Roll GR, Rouhani FJ, et al. The future of liver transplantation. Hepatology 2024;80:674-97. [Crossref] [PubMed]
2. Wang Y, Cao T, Liu X, et al. A New Benchmark for Modern Management of Valvular Heart Disease: The Whole-Life Cycle Management System. JACC Asia 2025;5:609-32. [Crossref] [PubMed]
3. Watt KD. Keys to long-term care of the liver transplant recipient. Nat Rev Gastroenterol Hepatol 2015;12:639-48. [Crossref] [PubMed]
4. International figures on organ donation and transplantation activities 2021. Available online: http://www.transplant-observatory.org
5. Lucey MR, Furuya KN, Foley DP. Liver Transplantation. N Engl J Med 2023;389:1888-900. [Crossref] [PubMed]
6. National data. Available online: http://optn.transplant.hrsa.gov/latestData/step2.asp
7. Fung J. The sleeping giant awakens-liver transplantation in China. Am J Transplant 2010;10:1723-4. [Crossref] [PubMed]
8. Rana A, Ackah RL, Webb GJ, et al. No Gains in Long-term Survival After Liver Transplantation Over the Past Three Decades. Ann Surg 2019;269:20-7. [Crossref] [PubMed]
9. Li X, Wang Y, Yang H, et al. Liver and Hepatocyte Transplantation: What Can Pigs Contribute? Front Immunol 2021;12:802692. [Crossref] [PubMed]
10. Transplantation Development in China (2023) [R]. Beijing: China Organ Transplantation Development Foundation; 2023.
11. Bajaj JS, Choudhury A, Kumaran V, et al. Geographic disparities in access to liver transplant for advanced cirrhosis: Time to ring the alarm! Am J Transplant 2024;24:733-42. [Crossref] [PubMed]
12. Ahmed O, Doyle MBM, Abouljoud MS, et al. Liver Transplant Costs and Activity After United Network for Organ Sharing Allocation Policy Changes. JAMA Surg 2024;159:939-47. [Crossref] [PubMed]
13. General Office of the State Council of the People’s Republic of China. The 14th Five-Year Plan for National Health [Z]. Guobanfa [2022] No. 11, 2022-04-27.
14. Jiménez-Romero C, Marcacuzco A, Caso O, et al. Long-Term Outcomes of Liver Transplant Recipients. What Do Patients Die From? World J Surg 2025;49:1632-42. [Crossref] [PubMed]
15. Webb GJ, Hodson J, Chauhan A, et al. Proximity to transplant center and outcome among liver transplant patients. Am J Transplant 2019;19:208-20. [Crossref] [PubMed]
16. Wang FS, Fan JG, Zhang Z, et al. The global burden of liver disease: the major impact of China. Hepatology 2014;60:2099-108. [Crossref] [PubMed]
17. Akbulut S, Colak C. Next-Generation Healthcare: Artificial Intelligence Applications in Disease Management. Diagnostics (Basel) 2024;14:1087. [Crossref] [PubMed]
18. Uche-Anya E, Anyane-Yeboa A, Berzin TM, et al. Artificial intelligence in gastroenterology and hepatology: how to advance clinical practice while ensuring health equity. Gut 2022;71:1909-15. [Crossref] [PubMed]
19. Ursic-Bedoya J, Donnadieu-Rigole H. Establishing a blueprint for successful liver transplantation for alcohol-related cirrhosis: the importance of a multidisciplinary team. Hepatobiliary Surg Nutr 2022;11:150-2. [Crossref] [PubMed]
20. Akbulut S, Ozer A, Saritas H, et al. Factors affecting anxiety, depression, and self-care ability in patients who have undergone liver transplantation. World J Gastroenterol 2021;27:6967-84. [Crossref] [PubMed]
21. Lei J, Yan L, Wang W. Donor safety in living donor liver transplantation: a single-center analysis of 300 cases. PLoS One 2013;8:e61769. [Crossref] [PubMed]
22. Oxenberg J, Papenfuss W, Esemuede I, et al. Multidisciplinary cancer conferences for gastrointestinal malignancies result in measurable treatment changes: a prospective study of 149 consecutive patients. Ann Surg Oncol 2015;22:1533-9. [Crossref] [PubMed]
23. Ursic-Bedoya J, Donnadieu-Rigole H. Establishing a blueprint for successful liver transplantation for alcohol-related cirrhosis: the importance of a multidisciplinary team. Hepatobiliary Surg Nutr 2022;11:150-2. [Crossref] [PubMed]
24. Wang C, Song D, Xu Z, et al. Clinical application of multidisciplinary teams in tumor therapy. Chin J Cancer Res 2017;29:168-70. [Crossref] [PubMed]
25. Coombs C, Cohen T, Duddy C, et al. Primary care micro-teams: an international systematic review of patient and healthcare professional perspectives. Br J Gen Pract 2023;73:e651-8. [Crossref] [PubMed]
26. Zaidan M, Legendre C. Solid Organ Transplantation in the Era of COVID-19: Lessons from France. Transplantation 2021;105:61-6. [Crossref] [PubMed]
27. Santonicola A, Zingone F, Camera S, et al. Telemedicine in the COVID-19 era for Liver Transplant Recipients: an Italian lockdown area experience. Clin Res Hepatol Gastroenterol 2021;45:101508. [Crossref] [PubMed]
28. Donahue AL, Rodriguez J, Shore JH. Telemental Health and the Management of Psychosis. Curr Psychiatry Rep 2021;23:27. [Crossref] [PubMed]
29. Perry TT, Turner JH. School-Based Telemedicine for Asthma Management. J Allergy Clin Immunol Pract 2019;7:2524-32. [Crossref] [PubMed]
30. Du Y, Zhou Q, Cheng W, et al. Factors Influencing Adoption and Use of Telemedicine Services in Rural Areas of China: Mixed Methods Study. JMIR Public Health Surveill 2022;8:e40771. [Crossref] [PubMed]
31. Gilkey MB, Kong WY, Kennedy KL, et al. Leveraging Telemedicine to Reduce the Financial Burden of Asthma Care. J Allergy Clin Immunol Pract 2022;10:2536-42. [Crossref] [PubMed]
32. Funderburk CD, Batulis NS, Zelones JT, et al. Innovations in the Plastic Surgery Care Pathway: Using Telemedicine for Clinical Efficiency and Patient Satisfaction. Plast Reconstr Surg 2019;144:507-16. [Crossref] [PubMed]
33. Kripalani S, Theobald CN, Anctil B, et al. Reducing hospital readmission rates: current strategies and future directions. Annu Rev Med 2014;65:471-85. [Crossref] [PubMed]
34. Sloth MMB, Neble Larsen E, Godtfredsen NS, et al. Impact of offspring and their educational level on readmission and death among older adults with chronic obstructive pulmonary disease: a nationwide cohort study using multistate survival models. J Epidemiol Community Health 2023;77:558-64. [Crossref] [PubMed]
35. Graboyes EM, Kallogjeri D, Zerega J, et al. Association of a Perioperative Education Program With Unplanned Readmission Following Total Laryngectomy. JAMA Otolaryngol Head Neck Surg 2017;143:1200-6. [Crossref] [PubMed]
36. Annema C, Drent G, Roodbol PF, et al. Trajectories of Anxiety and Depression After Liver Transplantation as Related to Outcomes During 2-Year Follow-Up: A Prospective Cohort Study. Psychosom Med 2018;80:174-83. [Crossref] [PubMed]
37. Kaplan A, Korenjak M, Brown RS Jr. Post-liver transplantation patient experience. J Hepatol 2023;78:1234-44. [Crossref] [PubMed]
38. Lieber SR, Jones AR, Jiang Y, et al. Psychiatric diagnoses are common after liver transplantation and are associated with increased health care utilization and patient financial burden. Liver Transpl 2024;30:1145-58. [Crossref] [PubMed]
39. Saracino RM, Jutagir DR, Cunningham A, et al. Psychiatric Comorbidity, Health-Related Quality of Life, and Mental Health Service Utilization Among Patients Awaiting Liver Transplant. J Pain Symptom Manage 2018;56:44-52. [Crossref] [PubMed]
40. Lieber SR, Baldelli L, Kim HP, et al. Active coping, resilience, post-traumatic growth, and psychiatric symptoms among early and late liver transplant survivors. Liver Transpl 2023;29:290-306. [Crossref] [PubMed]
41. Shibata N, Shimazaki H, Sano N, et al. Psychiatric and psychological outcomes of Japanese living donors following liver transplantation. Psychiatry Clin Neurosci 2009;63:583-5. [Crossref] [PubMed]
42. DiMartini AF, Trzepacz PT, Daviss SR. Prospective study of FK506 side effects: anxiety or akathisia? Biol Psychiatry 1996;40:407-11. [Crossref] [PubMed]
43. De Bona M, Ponton P, Ermani M, et al. The impact of liver disease and medical complications on quality of life and psychological distress before and after liver transplantation. J Hepatol 2000;33:609-15. [Crossref] [PubMed]
44. Ko D, Bratzke LC, Muehrer RJ, et al. Self-management in liver transplantation. Appl Nurs Res 2019;45:30-8. [Crossref] [PubMed]