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.
