Pediatric Liver Transplantation Outcomes: Insured vs. Uninsured Children.

According to the 2016 National Quality of Life Survey in Colombia, 95.4% of the population has a health insurance. Of these, 50.1% are contributors to the health care system, and 49.7% are subsidized patients that are unable to pay and are covered by the Government. A significant proportion of our patients belong to the subsidized system. That includes a low-income population with socio-cultural barriers, with difficulties in medication access and medical follow-up therefore a disadvantage population when compared to those with greater income. The purpose of this study was to compare the outcomes of contributing vs. subsidized patients after liver transplantation (LT). Methods and Materials See chart that reviews all pediatric patients that underwent LT in our center between January 2014 and October 2017. Mortality and complications after LT were analyzed in both groups. Kaplan-Meier was used to calculate complications and mortality. Survival comparison between groups, and time on waiting list, were calculated using the log-rank test. Results and Discussion A total of 73 children underwent LT. No significant gender difference was found (53.4% female and 46.6% male). Of the total, 26% were subsidized and 74% were contributing patients. Overall, the most frequent complications were: biliary complications (35.6%), acute rejection (23.3%), and surgical complications (15.1%). Comparing complications rates between subsidized and contributing group, we found no statistical difference in biliary complications (p=0.33), acute rejection (p=0.72), or surgical complications (p= 0.27). An evaluation showed a global mortality rate of 13.7%, with no statistically differences between groups (p=0.71). Conclusions The risks and outcomes are comparable for pediatric LT between insured and uninsured children in our center. Further studies with longer periods of follow- up are required in order to confirm if patients in a subsidized regimen have similar long- term outcomes.