PEDIATRIC LIVER TRANSPLANTATION IN THE BRAZILIAN UNIFIED HEALTH SYSTEM (SUS): REAL-WORLD RESOURCE UTILIZATION AND CLINICAL OUTCOMES (2015-2025)
Author(s)
Sandro Paino Paim, MSc1, Andre Luiz Bressan, MSc1, Melina Utz Melere, PhD2, Daniela Mayumi Rocha, PhD3, Erick Kazu, BSc3, Vinicius Goularte-Silva, BSc3.
1Biopas Brasil, São Paulo, Brazil, 2Hospital da Criança Santo Antônio, Porto Alegre, Brazil, 3Precision Data, São Paulo, Brazil.
1Biopas Brasil, São Paulo, Brazil, 2Hospital da Criança Santo Antônio, Porto Alegre, Brazil, 3Precision Data, São Paulo, Brazil.
OBJECTIVES: To quantify real-world healthcare resource utilization (HCRU), characterize post-transplant complication profiles, and evaluate geographic displacement among pediatric liver transplant (LT) recipients within the Brazilian Unified Health System (SUS). This pioneering investigation seeks to elucidate the complete and previously under-characterized patient care trajectory, thereby providing evidence to inform equitable allocation of public health resources.
METHODS: A retrospective cohort study (2015-2025) deterministically linked national national hospital (SIH) and ambulatory (SIA) databases. The index event was a pediatric LT admission. An outcome proxy was employed that reclassified undocumented loss to follow-up occurring within fewer than 180 days as early mortality, in order to address systemic deficiencies in patient tracking. Descriptive statistical methods were subsequently used to characterize healthcare resource utilization (HCRU), clinical complications, and patterns of geographic migration.
RESULTS: The cohort comprised 808 pediatric LT recipients. Post-transplant HCRU was massive: 6,360 hospitalizations, 1,401 ICU admissions, and 58,915 hospital days. Early readmissions (≤30 days) were critically high (n=244). Complication events included general intercurrences (43.8%), long-term (16.5%), surgical (13.6%), post-transplant lymphoproliferative disorder (9.7%), immunological (7.5%), and infectious (6.0%). Total deaths reached 192 (153 confirmed intra-hospital; 39 by proxy). A pronounced geographic displacement was observed, with patients forced to migrate to specialized centers predominantly in the South/Southeast.
CONCLUSIONS: To our knowledge, this pioneering study is the first to characterize the complete care continuum of pediatric LT in Brazil, bringing to light the hidden burden of severe complications, high readmissions, and forced geographic displacement. These previously untracked data reveal an emergent public health challenge. The true cost of this procedure encompasses both massive resource utilization and an immeasurable emotional and logistical toll on families. Addressing this burden necessitates not only decentralization of healthcare, but also investments in the development and implementation of novel therapeutic strategies aimed at preventing disease-related complications and enhancing long-term survival outcomes.
METHODS: A retrospective cohort study (2015-2025) deterministically linked national national hospital (SIH) and ambulatory (SIA) databases. The index event was a pediatric LT admission. An outcome proxy was employed that reclassified undocumented loss to follow-up occurring within fewer than 180 days as early mortality, in order to address systemic deficiencies in patient tracking. Descriptive statistical methods were subsequently used to characterize healthcare resource utilization (HCRU), clinical complications, and patterns of geographic migration.
RESULTS: The cohort comprised 808 pediatric LT recipients. Post-transplant HCRU was massive: 6,360 hospitalizations, 1,401 ICU admissions, and 58,915 hospital days. Early readmissions (≤30 days) were critically high (n=244). Complication events included general intercurrences (43.8%), long-term (16.5%), surgical (13.6%), post-transplant lymphoproliferative disorder (9.7%), immunological (7.5%), and infectious (6.0%). Total deaths reached 192 (153 confirmed intra-hospital; 39 by proxy). A pronounced geographic displacement was observed, with patients forced to migrate to specialized centers predominantly in the South/Southeast.
CONCLUSIONS: To our knowledge, this pioneering study is the first to characterize the complete care continuum of pediatric LT in Brazil, bringing to light the hidden burden of severe complications, high readmissions, and forced geographic displacement. These previously untracked data reveal an emergent public health challenge. The true cost of this procedure encompasses both massive resource utilization and an immeasurable emotional and logistical toll on families. Addressing this burden necessitates not only decentralization of healthcare, but also investments in the development and implementation of novel therapeutic strategies aimed at preventing disease-related complications and enhancing long-term survival outcomes.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO171
Topic
Clinical Outcomes, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Clinical Outcomes Assessment
Disease
Pediatrics