Liver transplantation is currently the treatment for individuals with end-stage liver disease. Liver transplantation may be performed with a cadaver or living donor. Individuals are prioritized for transplant by mortality risk and severity of illness criteria developed by the Organ Procurement and Transplantation Network and the United Network of Organ Sharing.
A liver transplant using a cadaver or living donor may be considered medically necessary for carefully selected individuals who meet the following criteria:
In ANY of the following situations, liver transplantation is considered experimental/investigational (E/I) and therefore non-covered because the safety and and/or effectiveness of this service cannot be established by the available published peer-reviewed literature:
Liver transplantation is considered not medically necessary for the following:
Potential contraindications for liver transplant recipients include, but are not limited to ANY of the following:
Liver re-transplantation may be considered medically necessary in individuals with:
In addition to the above criteria and subject to the discretion of the transplant center, a Hepatitis C Virus (HCV) positive donor organ maybe considered an acceptable organ option for an HCV negative adult recipient 18 years of age or older.
Liver transplantation or re-transplantation is considered not medically necessary for any other indications.
Covered diagnosis for procedure codes 47133, 47135, 47140, 47141, 47142, 47143, 47144, 47145, 47146, 47147, and 47399:
American Association for the Study of Liver Diseases et al
The American Association for the Study of Liver Diseases and the American Society of Transplantation (2013) issued joint guidelines on evaluating patients for liver transplant. These guidelines indicated liver transplantation for severe acute or advanced chronic liver disease after all effective medical treatments have been attempted. The formal evaluation should confirm the irreversible nature of the liver disease and lack of effective alternative medical therapy.
The guidelines also stated that liver transplant is indicated for the following conditions:
The American Association for the Study of Liver Diseases, the American Society of Transplantation, and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition issued joint guidelines on the evaluation of the pediatric patients for liver transplant in 2014. The guidelines stated that “disease categories suitable for referral to a pediatric LT program are similar to adults: acute liver failure, autoimmune, cholestasis, metabolic or genetic, oncologic, vascular, and infectious. However, specific etiologies and outcomes differ widely from adult patients, justifying independent pediatric guidelines.” The indications listed for liver transplantation included biliary atresia, Alagille syndrome, pediatric acute liver failure, hepatic tumors, HCC, hemangioendothelioma, cystic fibrosis-associated liver disease, urea cycle disorders, immune-mediated liver disease, along with other metabolic or genetic disorders.
National Comprehensive Cancer Network
The National Comprehensive Cancer Network (NCCN) guidelines on hepatobiliary cancers (v.3.2019) recommend referral to a liver transplant center or bridge therapy for patients with HCC meeting United Network of Organ Sharing criteria of a single tumor measuring 2 to 5 cm, or 2 to 3 tumors 3 cm or less with no macrovascular involvement or extrahepatic disease. Patients should be referred to the transplant center. Patients should be referred to the transplant center before the biopsy. In patients who are ineligible for transplant and in select patients with Child-Pugh class A or B liver function with tumors that are resectable, NCCN indicates resection is the preferred treatment option; locoregional therapy may also be considered. Patients with unresectable HCC should be evaluated for liver transplantation; if the patient is a transplant candidate, then referral to a transplant center should be given or bridge therapy should be considered. NCCN guidelines on hepatobiliary cancers also indicate that. These are level 2A recommendations based on lower-level evidence and uniform consensus.
The NCCN guidelines on neuroendocrine tumors (v.3.2019) indicate that liver transplantation for neuroendocrine liver metastases is considered investigational despite “encouraging” 5-year survival rates.