Effective Date: 01/01/1995
Title: Liver Transplant
Revision Date: 05/01/2015
CPT Code(s): 47133, 47135, 47140-47147
will apply to all services performed on or after the above revision date which
will become the new effective date.
services referred to in this policy that were performed before the revision
date, contact customer service for the rules that would apply.
maintains a national network of Centers of Excellence for members who require
Transplants and transplant related services are covered only when performed at a
transplant center previously approved by QualChoice.
Progressive liver diseases that
can result in death either in short-term or long-term is known as end-stage
liver disease (ESLD).
ESLD is treated with
transplantation of the liver.
Liver transplantation requires
(normal anatomical position) liver transplantation (with cadaver organ,
reduced-size organ, living related organ, and split liver) is considered
medically necessary for members with end-stage liver disease (ESLD) for:
(12 years to 18 years) and adults who meet the specific criteria below and
A Model of
End-stage Liver Disease (MELD) score (MELD
greater than 10; or
approved for transplant by the United Network for Organ Sharing (UNOS) Regional
less than 12 years of age who meet the transplanting institution`s selection
criteria and the specific criteria below. The transplant and transplant related
services will only be covered if the transplant center is an approved QualChoice
sclerosing cholangitis with development of secondary biliary cirrhosis
active hepatitis with cirrhosis (hepatitis B or C)
cirrhosis due to hepatitis B surface antigen negative state
hepatocellular carcinoma confined to the liver when all of the following
criteria are met:
Member is not
a candidate for subtotal liver resection; and
UNOS criteria for tumor size and number; and
There is no
macrovascular involvement; and
metastases have been shown to be responsive to chemotherapy; and
There is no
identifiable extrahepatic spread of tumor to surrounding lymph nodes, abdominal
organs, bone or other sites.
These criteria are intended to be consistent with United Network for Organ
Sharing (UNOS) guidelines for selection of liver transplant candidates for
Hepatoblastomas in children when all of the following criteria are met:
Member is not
a candidate for subtotal liver resection; and
meets UNOS criteria for tumor size and number; and
There is no
identifiable extrahepatic spread of tumor to surrounding lungs, abdominal
organs, bone or other sites. (Note: spread of hepatoblastoma to veins and
lymph nodes does not disqualify a member for coverage of a liver transplant.)
cholangiocarcinomas (i.e., cholangiocarcinomas confined to the liver);
unresectable fibrolamellar hepatocellular carcinomas;
neuroendocrine tumors (carcinoid tumors, apudomas, gastrinomas, glucagonomas) in
persons with severe symptoms and with metastases restricted to the liver, who
are unresponsive to adjuvant therapy after aggressive surgical resection
including excision of the primary lesion and reduction of hepatic metastases.
disorders and metabolic liver diseases with cirrhosis (not an all-inclusive
disease of the liver.
reactions (fulminant hepatic failure due to mushroom poisoning, acetaminophen
(Tylenol) overdose, etc.).
Portopulmonary hypertension (pulmonary hypertension associated with liver
disease or portal hypertension) in persons with a mean pulmonary artery pressure
by catheterization of less than 35 mm Hg.
Hepatopulmonary syndrome when the following selection criteria are met:
disease with non-cirrhotic portal hypertension; and
hypoxemia (PaO2 less than 60 mm Hg or AaO2 gradient greater than 20 mm Hg in
supine or standing position); and
Intrapulmonary vascular dilatation (as indicated by contrast-enhanced
echocardiography, technetium-99 macroaggregated albumin perfusion scan, or
Codes Used In This BI:
Removal of donor liver
Transplantation of liver
Partial removal donor liver
Partial removal donor liver
Partial removal donor liver
Prep donor liver whole
Prep donor liver 3-segment
Prep donor liver lobe split
Prep donor liver/venous
Prep donor liver/arterial
for liver transplantation for adolescents and adults with a MELD score of 10
or less who have not been approved by the UNOS Regional Review Board are not
QualChoice considers retransplantation following a failed liver transplant
medically necessary if the initial transplant was performed for a covered
QualChoice considers liver transplantation to be non covered for members with
any of the following absolute contraindications to liver transplantation:
of alcohol within the last six (6) months
of illicit drugs within the last six (6) months
of any substances within the last six (6) months
Active sepsis outside the biliary tract
Presence of significant organ system failure other than kidney, liver or
effective medical treatments or surgical options are available.
and Investigational Procedures:
QualChoice considers the following indications/procedures regarding liver
transplantation experimental and investigational:
Malignancies other than those listed as covered above
Ectopic or auxiliary liver transplantation
Progressive liver diseases that result in death either in short-term or
long-term is known as end-stage liver disease (ESLD), which is evidenced by
irreversible, progressive liver dysfunction, variceal bleeding, encephalopathy,
synthetic dysfunction, poor growth, or poor nutritional status. The most common
causes of ESLD include infection (e.g., acute or chronic hepatitis), toxic
effects (e.g., alcohol, medications), disorders of metabolism (e.g.,
hemochromatosis, Wilson`s disease), tumors (primary or metastatic), and
malformations (e.g., primary biliary atresia). Liver transplantation is an
effective treatment for fulminant (acute) hepatic failure and for many chronic
transplant is usually positioned in the normal anatomical position (orthotopic)
following a total hepatectomy of the recipient. In auxiliary liver
transplantation, a second liver is implanted ectopically and the recipient`s own
liver remains in situ. A major concern of ectopic transplantation is the
recipient`s diseased liver may harbor bacterial, fungal or viral infection or
cancer. Advances in surgical techniques and immunosuppressive drugs have
resulted in increased survival rates (with 1-year survival rates in the 85 to
90% range, and 5-year survival rates exceeding 70%). Currently, 10 to 20% of
liver transplanted patients are re-transplanted with a success rate of greater
C cirrhosis is the most common indication for liver transplantation. Alcoholic
liver disease remains a controversial indication for liver transplantation but
carefully selected patients do well. Some of the common indications for liver
transplantation are as follows:
Primary biliary cirrhosis
Primary sclerosing cholangitis
Chronic active hepatitis (usually
secondary to hepatitis B and C)
Alcoholic liver disease (after a
period of abstinence).
Hepatocellular carcinoma complicates many chronic liver diseases. However, a
small tumor is not a contraindication to transplantation since tumor rarely
recurs in these patients. In contrast, most patients with large (> 5 cm in
diameter) or multiple hepatomas or most other types of cancer are not considered
for transplantation since tumors recur rapidly. At present, there is
insufficient evidence that liver transplantation is an effective treatment for
other malignancies that affect the liver such as metastatic disease, bile duct
carcinoma, and epitheloid hemangioendothelioma, among others. An assessment by
the Agency for Healthcare Research and Quality (Beavers, et al., 2001) on liver
transplantation for malignancies other than hepatocellular carcinoma concluded
that “[t]he available evidence does not provide a clear profile of patients who
might be optimal candidates for such therapy.” Contraindications to liver
transplantation include extrahepatic malignancy, severe cardiopulmonary disease,
systemic sepsis, and an inability to comply with regular pharmacotherapy.
transplantation is an effective treatment for a variety of acute and chronic
diseases of the liver in the pediatric (< 18 years of age) population.
Approximately 15% of the liver transplantations performed yearly in the United
States are in pediatric patients. Most children who need liver transplantation
are young (age < 3 years) and small (body weight < 45 pounds). Size-matched
organs are given preference in organ allocation. However, because of the severe
scarcity of pediatric donor livers, techniques such as reduced size (“cut down”)
and split (a liver is split between 2 recipients) liver transplantations are
used to reduce the size of adult donor livers to fit pediatric recipients.
Donation of the left lobe of the liver by a living adult relative (“living
related donor”) is also an option. Liver transplantation in children is
indicated for ESLD from any etiology in the absence of contraindications. The
most common indication for pediatric liver transplantation is biliary atresia,
often after failure to respond to a portoenterostomy. In addition, unresectable
tumors and liver-based metabolic deficiencies may be indications for liver
for End-Stage Liver Disease (MELD) is a numerical scale, ranging from 6 (less
ill) to 40 (gravely ill), that is used for adult liver transplant candidates. It
gives each individual a `score` (number) based on how urgently he or she needs a
liver transplant within the next three months. The number is calculated by a
formula using bilirubin, prothrombin time, and creatinine. Candidates under the
age of 12 are placed in categories according to the Pediatric End-stage Liver
Disease (PELD) scoring system. PELD is similar to MELD but uses some different
criteria to recognize the specific growth and development needs of children.
PELD scores may also range higher or lower than the range of MELD scores. The
PELD scoring system takes into account the patient`s bilirubin, prothrombin
time, albumin, growth failure, and whether the child is less than one year old.
A liver transplantion is rarely necessary for persons with a MELD score of less
than 10. According to data from the United Network for Organ Sharing, of almost
5000 liver transplants that were performed in 2002, only 181 transplants were
performed on patients with a MELD score of less than 10.
score is a well-validated measure of short-term mortality from liver disease;
however, referring physicians who believe a patient faces a greater mortality
risk than predicted by the MELD/PELD score can request accelerated listing. UNOS
Regional Review Boards can approve or deny these requests, and a study by Voight,
et al. (2004) concluded that these boards fairly and accurately distinguish
between high and low risk patients. The study found that the denials of
physicians` requests for accelerated listings did not increase mortality for
those patients. To determine the effect of UNOS Regional Review Board decisions
on the mortality of physician-referred patients, investigators analyzed 1,965
nationwide referrals to UNOS Regional Review Boards. They noted which cases were
approved and which were denied, and gathered information about patient deaths
while awaiting transplantation. The investigators found that there was no
significant difference in survival to transplantation whether accelerated
listing was approved or denied for adult or pediatric cases. In addition, the
researchers examined whether or not referring physicians predicted death better
than the MELD/PELD score. The investigators found that the physicians had poor
predictive capacity and added no additional information to to the risk
assessment by the MELD/PELD score. The investigators concluded that the MELD-PELD
score is a better predictor of mortality than the judgement of the referring
physician, but the UNOS Regional Review Board process adds additional
information (see, e.g., Voight, et al., 2004).
success of transplantation has led to a marked increase in the number of
candidates to over 16,000 places on the national waiting list. However, there
has been little growth in the supply of available cadaveric organs, resulting in
an organ shortage crisis. With waiting times often exceeding 1 to 2 years, the
waiting list death rate now exceeds 10% in most regions. Researchers have
investigated novel approaches such as xenotransplantation, hepatocellular
transplantation and bioartificial liver to address the growing disparity between
the limited supply and excessive demand for suitable organs. However, all these
approaches are considered investigational in nature at this juncture.
xenotransplantation are performed using primates (e.g., baboons, and smaller
monkeys). Transmission of diseases, which can be transmitted from animals to
humans under natural conditions (zoonoses) as well as hyperacute rejection
remains major concerns in xenotransplantation. Hepatocellular transplantation is
used either to temporarily or permanently replace the diseased liver.
Hepatocytes are seeded onto biodegradable polymer that serves as a temporary
extracellular matrix and to induce vascular in-growth. The seeded polymer is
then implanted into a vascular rich area, such as the mesentery of the small
intestine. Other techniques including direct injection into the spleen or liver.
A bioartificial liver is designed to treat liver disease in the manner similar
to a dialysis machine treats renal disease. Investigators use porcine
hepatocytes or a transformed line of hepatocytes housed in a bioreactor allowing
plasma from patients with liver failure to perfuse through it. It can be used
either as a bridge to liver transplantation or to allow recovery of the native
and bioartificial livers have been developed for use as a bridge to transplant
in patients with liver failure or to allow recovery in persons with acute liver
failure. Liu, et al. (2004) reported on the results of a meta-analysis of twelve
trials of artificial or bioartificial support systems versus standard medical
therapy, involving 483 patients, and two trials comparing different artificial
support systems, involving 105 patients. Most trials had unclear methodological
quality. Compared to standard medical therapy, support systems had no
significant effect on mortality (relative risk 0.86; 95% confidence interval
0.65-1.12) or bridging to liver transplantation (relative risk 0.87; 95%
confidence interval 0.73-1.05), but a significant beneficial effect on hepatic
encephalopathy (relative risk 0.67; 95% confidence interval 0.52-0.86). Subgroup
analysis indicated that artificial and bioartificial livers may reduce mortality
by one-third in acute-on-chronic liver failure (relative risk 0.67; 95%
confidence interval 0.51-0.90), but not in acute liver failure (relative risk
0.95; 95% confidence interval 0.71-1.29). The authors noted that the incidence
of adverse events was inconsistently reported. The authors concluded that,
although artificial support systems may reduce mortality in acute-on-chronic
liver failure, “considering the strength of the evidence additional randomised
clinical trials are needed before any support system can be recommended for
recently, Demetriou, et al. (2004) reported on the first prospective, randomized
controlled trial of bioartificial liver, the HepatAssist Liver Support System in
171 patients with severe acute liver failure, including both
fulminant/subfulminant hepatic failure and primary nonfunction following liver
transplantation. For the entire patient population, survival at 30 days was 71%
for patients assigned to the bioartificial liver versus 62% for patients in the
control group (p = 0.26). After exclusion of primary nonfunction patients,
survival was 73% for persons assigned to the bioartificial liver versus 59% for
persons in the control group (p = 0.12). When survival was analyzed accounting
for confounding factors, in the entire patient population, there was no
difference between the two groups (risk ratio = 0.67; p = 0.13). However,
differences in survival between bioartificial liver and control patients with
fulminant/subfulminant hepatic failure reached marginal statistical significance
(risk ratio = 0.56; p = 0.048). The authors concluded that this study
demonstrated improved survival in patients with fulminant/subfulminant hepatic
failure. These results would need to be confirmed in additional prospective
randomized studies before conclusions can be drawn about the effectiveness of
the bioartificial liver.
al (2008) noted that deoxyguanosine kinase (DGUOK) deficiency is the commonest
type of mitochondrial DNA depletion associated with a hepatocerebral phenotype.
These researchers assessed predictors of survival and therapeutic options in
patients with DGUOK deficiency. A systematic search of MEDLINE, LILAC, and
SCIELO was performed to identify peer-reviewed clinical trials, randomized
controlled trials, meta-analyses, and other studies with clinical pertinence.
Deoxyguanosine kinase deficiency was searched with the terms dGK, DGUOK,
mitochondrial DNA depletion, mtDNA, and hepatocerebral. Bibliographies of
identified articles were reviewed for additional references. A total of 13
identified studies met the inclusion criteria and were used in this study. The
analysis revealed that DGUOK deficiency is associated with a variable clinical
phenotype. Long-term survival is best predicted by the absence of profound
hypotonia, significant psychomotor retardation, or nystagmus. In the presence of
these features, there is increased mortality, and liver transplantation does not
confer increased survival. The authors concluded that liver transplantation
appears to be futile in the presence of specific neurological signs or symptoms
in patients affected with DGUOK deficiency. Conversely, in the absence of these
neurological features, liver transplantation may be considered a potential
Bancel B, Patricot LM, Caillon P,
et al. [Hepatic epithelioid hemangioendothelioma. A case with liver
transplantation. Review of the literature.] Ann Pathol. 1993;13(1):23-28.
Chui AK, Jayasundera MV, Haghighi
KS, et al. Octreotide scintigraphy: A prerequisite for liver transplantation
for metastatic gastrinoma. Aust N Z J Surg. 1998;68(6):458-460.
Gottwald T, Koveker G, Busing M,
et al. Diagnosis and management of metastatic gastrinoma by multimodality
treatment including liver transplantation: Report of a case. Surg Today.
Benhamou G, Marmuse JP, Le Goff
JY, et al. [Pancreatic gastrinoma with hepatic metastasis treated by
supra-mesocolic exenteration and hepatic transplantation.] Presse Med.
Alsina AE, Bartus S, Hull D, et
al. Liver transplant for metastatic neuroendocrine tumor. J Clin
Katzenstein HM, Rigsby C, Shaw
PH, et al. Novel therapeutic approaches in the treatment of children with
hepatoblastoma. J Pediatr Hematol Oncol. 2002;24(9):751-755.
Srinivasan P, McCall J, Pritchard
J, et al. Orthotopic liver transplantation for unresectable hepatoblastoma.
Pimpalwar AP, Sharif K, Ramani P,
et al. Strategy for hepatoblastoma management: Transplant versus
nontransplant surgery. J Pediatr Surg. 2002;37(2):240-245.
Chardot C, Saint Martin C, Gilles
A, et al. Living-related liver transplantation and vena cava reconstruction
after total hepatectomy including the vena cava for hepatoblastoma.
Molmenti EP, Nagata D, Roden J,
et al. Liver transplantation for hepatoblastoma in the pediatric population.
Transplant Proc. 2001;33(1-2):1749.
Reyes JD, Carr B, Dvorchik I, et
al. Liver transplantation and chemotherapy for hepatoblastoma and
hepatocellular cancer in childhood and adolescence. J Pediatr.
Al-Qabandi W, Jenkinson HC,
Buckels JA, et al. Orthotopic liver transplantation for unresectable
hepatoblastoma: A single center`s experience. J Pediatr Surg.
Achilleos OA, Buist LJ, Kelly DA,
et al. Unresectable hepatic tumors in childhood and the role of liver
transplantation. J Pediatr Surg. 1996;31(11):1563-1567.
Superina R, Bilik R. Results of
liver transplantation in children with unresectable liver tumors. J Pediatr
Pichlmayr R, Weimann A, Oldhafer
KJ, et al. Role of liver transplantation in the treatment of unresectable
liver cancer. World J Surg. 1995;19(6):807-813.
Lockwood L, Heney D, Giles GR, et
al. Cisplatin-resistant metastatic hepatoblastoma: Complete response to
carboplatin, etoposide, and liver transplantation. Med Pediatr Oncol.
Tagge EP, Tagge DU, Reyes J, et
al. Resection, including transplantation, for hepatoblastoma and
hepatocellular carcinoma: Impact on survival. J Pediatr Surg.
Koneru B, Flye MW, Busuttil RW,
et al. Liver transplantation for hepatoblastoma. The American experience.
Ann Surg. 1991;213(2):118-121.
Carithers RL Jr. Liver
transplantation. American Association for the Study of Liver Diseases. Liver
Krowka MJ. Hepatopulmonary
syndrome: Recent literature (1997 to 1999) and implications for liver
transplantation. Liver Transpl. 2000;6(4 Suppl 1):S31-S35.
Aboussouan LS, Stoller JK. The
hepatopulmonary syndrome. Baillieres Best Pract Res Clin Gastroenterol.
Das K, Kar P. Hepatopulmonary
syndrome. J Assoc Physicians India. 2002;50:1049-1056.
Hoekstra R, Chamuleau RA. Recent
developments on human cell lines for the bioartificial liver. Int J Artif
Ryder SD; British Society of
Gastroenterology. Guidelines for the diagnosis and treatment of
hepatocellular carcinoma (HCC) in adults. Gut. 2003;52 Suppl 3:iii1-8.
Krasko A, Deshpande K, Bonvino S.
Liver failure, transplantation, and critical care. Crit Care Clin.
Noorani HZ, McGahan L. Criteria
for selection of adult recipients for heart, cadaveric kidney and liver
transplantation. Ottawa, ON: Canadian Coordinating Office for Health
Technology Assessment (CCOHTA); 1999.
Swedish Council on Technology
Assessment in Health Care (SBU). Dialysis for acute hepatic failure - early
assessment briefs (ALERT). Stockholm, Sweden: SBU; 2000.
Pons JMV. Living donor liver
transplant. Barcelona, Spain: Catalan Agency for Health Technology
Assessment and Research (CAHTA); 2001.
Agency for Healthcare Research
and Quality (AHRQ). Morbidity and mortality among adult living donors
undergoing right hepatic lobectomy for adult recipients (living donor liver
transplantation) - systematic review. Rockville, MD: AHRQ; 2001.
Alberta Heritage Foundation for
Medical Research (AHFMR). Liver Dialysis Unit System. Edmonton, AB: AHFMR;
Devlin J, O`Grady J. Indications
for referral and assessment in adult liver transplantation: A clinical
guideline. BSG Guidelines in Gastroenterology. London, UK: British Society
of Gastroenterology (BSG); September 2000.
Beavers KL, Bonis PAL, Lau J.
Liver transplantation for patients with hepatobiliary malignancies other
than hepatocellular carcinoma. Rockville, MD: Agency for Healthcare Research
and Quality (AHRQ); 2001.
National Horizon Scanning Centre
(NHSC). MARS: A liver assist device - horizon scanning review. Birmingham,
UK: NHSC; 2003.
Comite d` Evaluation et de
Diffusion des Innovations Technologiques (CEDIT). MARS liver support
(Molecular Adsorbents Recirculating System). Paris, France: CEDIT; 2003.
Liu J, Gluud L, Als-Nielsen B,
Gluud C. Artificial and bioartificial support systems for liver failure.
Cochrane Database Syst Rev. 2004;1:CD003628.
Demetriou AA, Brown RS Jr,
Busuttil RW, et al. Prospective, randomized, multicenter, controlled trial
of a bioartificial liver in treating acute liver failure. Ann Surg.
Canadian Coordinating Office for
Health Technology Assessment (CCOHTA). Living donor liver transplantation.
Pre-Assessment No. 24. Ottawa, ON: CCOHTA; October 2003.
National Institute for Clinical
Excellence (NICE). Extracorporeal albumin dialysis for acute-on-chronic
liver failure. Interventional Procedure Guidance 45. London, UK: NICE;
Scott A. Living donor liver
transplantation in children. IP-21 Information Paper. Edmonton, AB: Alberta
Heritage Foundation for Medical Research (AHFMR); 2004.
Middleton P, Duffield M, Lynch S,
et al. Live donor liver transplantation adult outcomes: A systematic review.
ASERNIP-S Report No. 22 (Adult Donor Outcomes) and ASERNIP-S Report No. 34
(Adult Recipient Outcomes). Stepney, South Australia: Australian Safety and
Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S);
October 29, 2004.
de Rave S, Hansen BE, Groenland
TH, et al. Heterotopic vs. orthotopic liver transplantation for chronic
liver disease: A case-control comparison of short-term and long-term
outcomes. Liver Transpl. 2005;11(4):396-401.
Harimoto N, Taketomi A, Kitagawa
D, et al. The newly established human hepatocyte cell line: Application for
the bioartificial liver. J Hepatol. 2005;42(4):557-564.
United Network for Organ Sharing
(UNOS). MELD/PELD calculator. UNOS Resources. Richmond, VA: UNOS; 2005.
Murray KF, Carithers RL Jr. AASLD
practice guidelines: Evaluation of the patient for liver transplantation.
National Health Service,
UKTransplant, Liver organ allocation. Organ Allocation. London, UK:
UKTransplant; 2006. Available at:
Hoeper MM, Krowka MJ, Strassburg
CP. Portopulmonary hypertension and hepatopulmonary syndrome. Lancet.
Galie N, Torbicki A, Barst R, et
al.; Task Force. Guidelines on diagnosis and treatment of pulmonary arterial
hypertension. The Task Force on Diagnosis and Treatment of Pulmonary
Arterial Hypertension of the European Society of Cardiology. Eur Heart J.
Badesch DB, Abman SH, Ahearn GS,
et al. Medical therapy for pulmonary arterial hypertension: ACCP
evidence-based clinical practice guidelines. Chest. 2004;126(1
National Institute for Health and
Clinical Excellence (NICE). Living-donor liver transplantation.
Interventional Procedure Guidance 194. London, UK: NICE; 2006.
Chamuleau RA, Poyck PP, van de
Kerkhove MP. Bioartificial liver: Its pros and cons. Ther Apher Dial.
Voigt MD, Zimmerman B, Katz DA,
Rayhill SC. New national liver transplant allocation policy: Is the regional
review board process fair? Liver Transplant. 2004;10(5):666-674.
Ibrahim Z, Busch J, Awwad M, et
al. Selected physiologic compatibilities and incompatibilities between human
and porcine organ systems. Xenotransplantation. 2006;13(6):488-499.
Mehrabi A, Kashfi A, Fonouni H,
et al. Primary malignant hepatic epithelioid hemangioendothelioma: A
comprehensive review of the literature with emphasis on the surgical
therapy. Cancer. 2006;107(9):2108-2121.
Elsharkawi M, Staib L,
Henne-Bruns D, Mayer J. Complete remission of postransplant lung metastases
from hepatocellular carcinoma under therapy with sirolimus and mycophenolate
mofetil. Transplantation. 2005;79(7):855-857.
Bazan HA, McMurtry KA, Waters PF,
Thung SN. Surgical resection of pulmonary metastases after orthotopic liver
transplantation for hepatocellular carcinoma. Transplantation.
Said A, Einstein M, Lucey MR.
Liver transplantation: an update 2007. Curr Opin Gastroenterol.
Segev DL, Sozio SM, Shin EJ, et
al. Steroid avoidance in liver transplantation: Meta-analysis and
meta-regression of randomized trials. Liver Transpl. 2008;14(4):512-525.
Gurusamy KS, Kumar Y, Davidson
BR. Methods of preventing bacterial sepsis and wound complications for liver
transplantation. Cochrane Database Syst Rev. 2008;(4):CD006660.
Dimmock DP, Dunn JK, Feigenbaum
A, et al. Abnormal neurological features predict poor survival and should
preclude liver transplantation in patients with deoxyguanosine kinase
deficiency. Liver Transpl. 2008;14(10):1480-1485.
Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.