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Liver transplantation for children with biliary atresia in the pediatric end-stage liver disease era: The role of insurance status
Article first published online: 12 MAR 2013
Copyright © 2013 American Association for the Study of Liver Diseases
Volume 19, Issue 5, pages 543–550, May 2013
How to Cite
Arnon, R., Annunziato, R. A., Willis, A., Parbhakar, M., Chu, J., Kerkar, N. and Shneider, B. L. (2013), Liver transplantation for children with biliary atresia in the pediatric end-stage liver disease era: The role of insurance status. Liver Transpl, 19: 543–550. doi: 10.1002/lt.23607
This work was presented in part at the 2012 American Transplant Conference in Boston, MA.
- Issue published online: 25 APR 2013
- Article first published online: 12 MAR 2013
- Accepted manuscript online: 27 FEB 2013 03:11PM EST
- Manuscript Accepted: 20 DEC 2012
- Manuscript Received: 8 JUL 2012
Socioeconomic status influences health outcomes, although its impact on liver transplantation (LT) in children with biliary atresia (BA) is unknown. We hypothesized that governmental insurance [public insurance (PU)], rather than private insurance (PR), would be associated with poorer outcomes for children with BA. Children with BA who underwent first isolated LT between January 2003 and June 2011 were identified from United Network for Organ Sharing Standard Transplant Analysis and Research files. We identified 757 patients with PR and 761 patients with PU. The race/ethnicity distribution was significantly different between the groups (65% white, 12% black, and 10% Hispanic in the PR group and 33% white, 26% black, and 29% Hispanic in the PU group, P < 0.01). Wait-list mortality was higher for the PU group versus the PR group [46/1654 (2.7%) versus 29/1895 (1.5%), P < 0.01]. PR patients were older than PU patients at transplant (2.4 ± 4.5 versus 1.5 ± 3.0 years, P < 0.01). The donor types differed between the groups: 165 children (21.8%) in the PR group received living donor grafts, whereas 79 children (10.4%) in the PU group did (P < 0.01). The 1- and 5-year posttransplant patient survival rates were greater for the PR group versus the PU group (98.0% versus 94.1% at 1 year, P < 0.01; 97.8% versus 92.2% at 5 years, P < 0.01). Cox proportional hazards models revealed that the insurance type (PU), the donor type (deceased), and life support were significant risk factors for death. A separate analysis of deceased donor LT revealed that the PU group still had significantly worse patient and graft survival. In conclusion, PU coverage is an independent risk factor for significantly increased wait-list and posttransplant mortality in children with BA. Further studies are needed to unearth the reasons for these important differences in outcomes. Liver Transpl 19:543–550, 2013. © 2013 AASLD.