Objective: Kidney transplantation requires a multidisciplinary approach to achieve optimal outcomes. Healthcare fragmentation can negatively impact clinical outcomes; however, this issue remains understudied in low- and middle-income countries (LMICs). This study aimed to assess healthcare fragmentation in kidney transplant patients during their first post-transplant year and evaluate its association with three-year survival among patients enrolled in Colombia's contributory healthcare scheme.   Methods: A retrospective cohort study was conducted using administrative data from Colombia's contributory healthcare scheme. The cohort included kidney transplant recipients (2012–2016) who survived the first post-transplant year. Healthcare fragmentation was measured by the number of unique providers involved in the first year. Patients were categorised into high- and low-fragmentation groups based on the 75th percentile of provider distribution. The primary outcome was three-year survival, analysed using multivariate Cox regression to estimate hazard ratios (HRs), adjusted for age, sex, Charlson Comorbidity Index (CCI), insurer, region, and transplant year.   Results: The cohort comprised 2,028 kidney transplant patients, with a mean age of 47.7 years (SD: 13.4), 38.7% female, and 68.7% presenting a CCI≤3. Healthcare fragmentation ranged from 1 to 34 providers, with a mean of 8.94 (SD: 6.77). High fragmentation (≥11 providers) was observed in 30.2% of patients. Three-year mortality was significantly higher in the high-fragmentation group (18%) compared to the low-fragmentation group (12%) (p=0.04). High fragmentation was associated with a 49% increased mortality risk (adjusted HR: 1.49; 95% CI: 1.12–1.97; p=0.01).   Conclusion: Healthcare fragmentation significantly reduces three-year overall survival in kidney transplant recipients in Colombia. These findings underscore the importance of integrated care models and improved coordination among providers to enhance patient outcomes, particularly in resource-limited settings.

The authors have declared no competing interest.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study was approved by the Faculty of Medicine Ethics Committee at the Universidad Nacional de Colombia (Approval Number: 004-029).

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The following information sources: Single Registry of Enrollees, Mortality Registry Module from the Unified Affiliation Registry (RUAF) and Calculation Study of the Capitation Unit Database (Base del Estudio de Suficiencia de la Unidad Por Capitación, or UPC) are administered by the Colombian Ministry of Health and Social Protection. These databases are freely available upon request to the Technology of the Information and Communication Office of the Colombian Ministry of Health and Social Protection through the e-mail: correo@minsalud.gov.co.