Paterno Flavio, Lee-Riddle Grace S, Olivo Raquel, Amin Arpit N, Koneru Baburao, Pyrsopoulos Nikolaos T, Lunsford Keri E, Guarrera James V
Department of Surgery, Division of Liver Transplant and Hepatobiliary Surgery, Rutgers New Jersey Medical School and University Hospital, Newark, New Jersey, USA.
Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School and University Hospital, Newark, New Jersey, USA.
Liver Transpl. 2025 Jul 1;31(7):924-934. doi: 10.1097/LVT.0000000000000495. Epub 2024 Sep 27.
The lack of health insurance is a major barrier to access to health care, even in the case of life-saving procedures such as liver transplantation (LT). Concerns about worse outcomes in uninsured patients have also discouraged the evaluation and transplantation of patients without adequate health insurance coverage. The aim of this study is to evaluate outcomes from the largest cohort of uninsured patients who underwent LT with the support of a state payment assistance program (also called charity care). This study included all consecutive patients who underwent LT at a single center from 2002 to 2020. Demographic, clinical, and social variables and outcome metrics were collected and compared between insured and uninsured patients. Among a total of 978 LT recipients, 594 had private insurance, 324 government insurance (Medicare/Medicaid), and 60 were uninsured and covered under a state charity care program. In the charity care group, there was a higher proportion of Hispanic subjects, single marital status, younger age, and high-MELD score patients. The 1- and 3-year patient survival rates were 89.0% and 81.8% in private insurance patients, 88.8% and 80.1% in government insurance recipients, and 93.3% and 79.6% in those with charity care ( p =0.49). There was no difference in graft survival between insured and uninsured patients ( p =0.62). The 3 insurance groups presented similar hospital length-of-stay and 30-day readmission rates. In both univariate and multivariate analysis, uninsured status (charity care) was not associated with worse patient survival (HR: 1.23, 95% CI: 0.84-1.80, p =0.29) or graft survival (HR: 1.22, 95% CI: 0.84-1.78, p =0.29). In conclusion, there was no difference in outcomes after LT between insured and uninsured patients. A charity care program may be an effective tool to mitigate socioeconomic disparities in both outcomes and access to LT.
缺乏医疗保险是获得医疗保健的主要障碍，即使在诸如肝移植（LT）这种挽救生命的手术中也是如此。对未参保患者预后较差的担忧也阻碍了对没有足够医疗保险覆盖的患者进行评估和移植。本研究的目的是评估在一项州支付援助计划（也称为慈善医疗）支持下接受LT的最大规模未参保患者队列的预后。本研究纳入了2002年至2020年在单一中心接受LT的所有连续患者。收集了参保和未参保患者的人口统计学、临床和社会变量以及预后指标并进行比较。在总共978例LT受者中，594例有私人保险，324例有政府保险（医疗保险/医疗补助），60例未参保且参加了州慈善医疗计划。在慈善医疗组中，西班牙裔受试者、单身婚姻状况、较年轻年龄以及高终末期肝病模型（MELD）评分患者的比例更高。私人保险患者的1年和3年患者生存率分别为89.0%和81.8%，政府保险受者为88.8%和80.1%，慈善医疗患者为93.3%和79.6%（p =0.49）。参保和未参保患者的移植物生存率无差异（p =0.62）。这3个保险组的住院时间和30天再入院率相似。在单因素和多因素分析中，未参保状态（慈善医疗）与较差的患者生存率（风险比：1.23，95%置信区间：0.84 - 1.80，p =0.29）或移植物生存率（风险比：1.22，95%置信区间：0.84 - 1.78，p =0.29）均无关。总之，参保和未参保患者LT后的预后无差异。慈善医疗计划可能是减轻LT预后和可及性方面社会经济差异的有效工具。
