Small Bowel and Multivisceral Transplants in Adults and Children 7.02.05
Excellus BlueCross BlueShield policy 07.02.05 covers small bowel (SB) transplant in pediatric and adult patients with short bowel syndrome for listed indications. These include impending or overt liver failure from TPN-induced liver injury, thrombosis of two or more central veins, two or more hospitalized episodes per year of line-related systemic sepsis, a single episode of line-related fungemia, septic shock or acute respiratory distress syndrome, and frequent episodes of severe dehydration despite IV fluids plus TPN. Multivisceral transplant is considered medically appropriate in pediatric and adult patients with intestinal failure and concurrent liver failure. SB transplant for patients with intestinal failure who can tolerate TPN, and SB transplant using live donor tissue, are considered investigational. Candidates must also meet listed criteria for cardiopulmonary status, absence of active infection, absence of malignancy, and documented compliance with medical management.