Medical policy: Liver Transplant and Combined Liver-Kidney Transplant

Número de política: MP 9.006

Fecha de entrada en vigor: 2/1/2026

Política

A liver transplant, using a cadaver or living donor, is medically necessary for carefully selected individuals with end-stage liver failure due to irreversibly damaged livers.

Etiologies of end-stage liver disease include, but are not limited to, the following:

• Hepatocellular diseases
  • Alcoholic liver disease
  • Viral hepatitis (either A, B, C, or non-A, non-B)
  • Autoimmune hepatitis
  • Alpha-1 antitrypsin deficiency
  • Hemochromatosis
  • Non-alcoholic steatohepatitis
  • Protoporphyria
  • Wilson disease
• Cholestatic liver diseases
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis with development of secondary biliary cirrhosis
  • Biliary atresia
• Vascular disease
  • Budd-Chiari syndrome
• Primary hepatocellular carcinoma (see Policy Guidelines section for individual selection criteria)
• Inborn errors of metabolism
• Trauma and toxic reactions
• Varios
  • Familial amyloid polyneuropathy

Liver transplantation may be considered medically necessary in individuals with polycystic disease of the liver who have massive hepatomegaly causing obstruction or functional impairment.

Liver transplantation may be considered medically necessary in individuals with unresectable hilar cholangiocarcinoma (see Policy Guidelines for individual selection criteria).

Liver transplantation may be considered medically necessary in pediatric individuals with nonmetastatic hepatoblastoma.

Liver retransplantation may be considered medically necessary in individuals with:

• Primary graft nonfunction
• Hepatic artery thrombosis
• Chronic rejection
• Ischemic type biliary lesions after donation after cardiac death
• Recurrent non-neoplastic disease causing late graft failure

Combined liver-kidney transplantation may be considered medically necessary in individuals who qualify for liver transplantation and have advanced irreversible kidney disease.

Liver transplantation is considered investigational in the following individuals as there is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure:

• Individuals with an intrahepatic cholangiocarcinoma
• Individuals with neuroendocrine tumors metastatic to the liver

Liver transplantation is considered investigational in the following individuals:

• Individuals with hepatocellular carcinoma that has extended beyond the liver (see Policy Guidelines)
• Individuals with ongoing alcohol and/or drug abuse (evidence for abstinence may vary among liver transplant programs, but generally a minimum of 3 months is required)

Liver transplantation is considered investigational in all other situations not described above as there is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Directrices de la política

Contraindications

Potential contraindications subject to the judgment of the transplant center include:

1. Known current malignancy, including metastatic cancer
2. Recent malignancy with high risk of recurrence
3. Untreated systemic infection making immunosuppression unsafe, including chronic infection
4. Other irreversible end-stage disease not attributed to liver disease
5. History of cancer with a moderate risk of recurrence
6. Systemic disease that could be exacerbated by immunosuppression
7. Psychosocial conditions or chemical dependency affecting ability to adhere to therapy

Note that liver transplantation for those with T3 hepatocellular carcinoma (HCC) is not prohibited by United Network for Organ Sharing (UNOS) guidelines, but these individuals do not receive any priority on the waiting list. All individuals with HCC awaiting transplantation are reassessed at 3-month intervals. Those whose tumors have progressed and are no longer T2 tumors will lose the additional allocation points.

Additionally, nodules identified through imaging of cirrhotic livers are given a Class 5 designation. Class 5B and 5T nodules are eligible for automatic priority. Class 5B criteria consist of a single nodule 2 cm or larger and up to 5 cm (T2 stage) that meets specified imaging criteria. Class 5T nodules have undergone subsequent locoregional treatment after being automatically approved on initial application or extension. A single Class 5A nodule (greater than 1 cm and less than 2 cm) corresponds to T1 HCC and does not qualify for automatic priority. However, combinations of Class 5A nodules are not automatic priority if they meet stage T2 criteria. Class 5X lesions are outside of stage T2 and are not eligible for automatic exception points. Nodules less than 1 cm are considered indeterminate and are not considered for additional priority. Therefore, the UNOS allocation system provides strong incentives to use locoregional therapies to downsize tumors to T2 status and to prevent progression while on the waiting list.

Cholangiocarcinoma

According to Organ Procurement and Transplantation Network (OPTN) policy on liver allocation, candidates with cholangiocarcinoma (CCA) meeting the following criteria will be eligible for a Model for End‑stage Liver Disease (MELD) or Pediatric End‑stage Liver Disease (PELD) exception with a 10% mortality equivalent increase every 3 months:

• Centers must submit a written protocol for patient care to the OPTN and UNOS Liver and Intestinal Organ Transplantation Committee before requesting a MELD score exception for a candidate with cholangiocarcinoma. This protocol should include selection criteria, administration of neoadjuvant therapy before transplantation, and operative staging to exclude individuals with regional hepatic lymph node metastases, intrahepatic metastases, and/or extrahepatic disease. The protocol should include data collection as deemed necessary by the OPTN/UNOS Liver and Intestinal Organ Transplantation Committee.
• Candidates must satisfy diagnostic criteria for hilar CCA: malignant-appearing stricture on cholangiography and one of the following: carbohydrate antigen 19-9 greater than 100 U/mL, or biopsy or cytology results demonstrating malignancy, or aneuploidy. The tumor should be considered unresectable on the basis of technical considerations or underlying liver disease (e.g., primary sclerosing cholangitis).
• If cross‑sectional imaging studies (computed tomography [CT] scan, ultrasound, magnetic resonance imaging [MRI]) demonstrate a mass, the mass should be less than 3 cm.
• Intra‑ and extrahepatic metastases should be excluded by cross‑sectional imaging studies of the chest and abdomen at the time of initial exception and every 3 months before score increases.
• Regional hepatic lymph node involvement and peritoneal metastases should be assessed by operative staging after completion of neoadjuvant therapy and before liver transplantation. Endoscopic ultrasound-guided aspiration of regional hepatic lymph nodes may be advisable to exclude individuals with obvious metastases before neoadjuvant therapy is initiated.
• Transperitoneal aspiration or biopsy of the primary tumor (either by endoscopic ultrasound, operative, or percutaneous approaches) should be avoided because of the high risk of tumor seeding associated with these procedures.

Donor criteria: Living donor liver transplant

Donor morbidity and mortality are prime concerns in donors undergoing right lobe, left lobe, or left lateral segment donor partial hepatectomy as part of living donor liver transplantation. Partial hepatectomy is a technically demanding surgery, the success of which may be related to the availability of an experienced surgical team. In 2000, the American Society of Transplant Surgeons proposed the following guidelines for living donors:

• Should be healthy individuals who are carefully evaluated and approved by a multidisciplinary team including hepatologists and surgeons to assure that they can tolerate the procedure
• Should undergo evaluation to assure that they fully understand the procedure and associated risks
• Should be of legal age and have sufficient intellectual ability to understand the procedures and give informed consent
• Should be emotionally related to the recipients
• Must be excluded if the donor is felt or known to be coerced
• Need to have the ability and willingness to comply with long-term follow-up

Cross-reference:

• MP 9.013 Isolated Small Bowel Transplant and Small Bowel/Liver and Multivisceral Transplant

Variaciones del producto

Esta política solo se aplica a ciertos programas y productos administrados por Capital Blue Cross y está sujeta a variaciones en los beneficios. Consulte la información adicional a continuación.

FEP PPO - Consulte el Manual de Políticas Médicas de FEP.

Descripción/Antecedentes

Solid organ transplantation offers a treatment option for patients with different types of end stage organ failure that can be lifesaving or provide significant improvements to a patient's quality of life. Many advances have been made in the last several decades to reduce perioperative complications. Available data supports improvement in long-term survival as well as improved quality of life particularly for liver, kidney, pancreas, heart, and lung transplants. Allograft rejection remains a key early and late complication risk for any organ transplantation. Transplant recipients require life-long immunosuppression to prevent rejection. Patients are prioritized for transplant by mortality risk and severity of illness criteria developed by Organ Procurement and Transplantation Network and United Network of Organ Sharing.

Liver transplantation

Liver transplantation is routinely performed as a treatment of last resort for patients with end-stage liver disease. Liver transplantation may be performed with a living donation after brain or cardiac death or with a live segment donation from a living donor. Certain populations are prioritized as Status 1A (e.g., acute liver failure with a life expectancy of fewer than 7 days without a liver transplant) or Status 1B (pediatric patients with chronic liver disease). Following Status 1, donor livers are prioritized to those with the highest scores on the Model for End-stage Liver Disease (MELD) and Pediatric End-stage Liver Disease (PELD) scales.

Due to the scarcity of donor livers, a variety of strategies have been developed to expand the donor pool. For example, a split graft refers to dividing a donor liver into 2 segments that can be used for 2 recipients. Living donor (LD) liver transplantation (LT) is now commonly performed for adults and children from a related or unrelated donor. Depending on the graft size needed for the recipient, either the right lobe, left lobe, or the left lateral segment can be used for LD LT.

In addition to addressing the problem of donor scarcity, LD LT allows the procedure to be scheduled electively before the recipient's condition deteriorates or serious complications develop. Living donor LT also shortens the preservation time for the donor liver and decreases disease transmission from donor to recipient.

Regulatory status

Solid organ transplants are a surgical procedure and, as such, are not subject to regulation by the U.S. Food and Drug Administration (FDA).

The FDA regulates human cells and tissues intended for implantation, transplantation, or infusion through the Center for Biologics Evaluation and Research, under Code of Federal Regulation Title 21, parts 1270 and 1271. Solid organs used for transplantation are subject to these regulations.

Fundamento

Summary of evidence

For individuals who have hepatocellular disease who receive a liver transplant, the evidence includes registry studies and systematic reviews. Relevant outcomes include overall survival, morbid events, and treatment-related morbidity and mortality. Studies on liver transplantation for viral hepatitis have found that survival is lower than for other liver diseases. Although these statistics raise questions about the most appropriate use of a scarce resource (donor livers), long-term survival rates are significant in a group of patients who have no other treatment options. Also, survival can be improved by the eradication of the hepatitis virus before transplantation. For patients with non-alcoholic steatohepatitis (NASH), overall survival rates have been shown to be similar to other indications for liver transplantation. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome.

For individuals who have primary hepatocellular carcinoma who receive a liver transplant, the evidence includes systematic reviews of observational studies. Relevant outcomes include overall survival, morbid events, and treatment-related morbidity and mortality. In the past, long-term outcomes in patients with primary hepatocellular malignancies had been poor compared with the overall survival of liver transplant recipients. However, the recent use of standardized patient selection criteria (e.g., the Milan criteria diameter) has dramatically improved overall survival rates. In appropriately selected patients, liver transplant has been shown to result in higher survival rates than resection. In patients who present with unresectable organ-confined disease, transplant represents the only curative approach. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome.

For individuals who have extrahepatic cholangiocarcinoma who receive a liver transplant, the evidence includes individual registry studies and systematic reviews of observational studies. Relevant outcomes include overall survival, morbid events, and treatment-related morbidity and mortality. For patients with extrahepatic (hilar or perihilar) cholangiocarcinoma who are treated with adjuvant chemotherapy, 5-year survival rates have been reported as high as 76%. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome.

For individuals who have intrahepatic cholangiocarcinoma who receive a liver transplant, the evidence includes registry studies and a systematic review of observational studies. Relevant outcomes include overall survival, morbid events, and treatment-related morbidity and mortality. In a registry study comparing outcomes in patients with intrahepatic cholangiocarcinoma who received liver transplantation to those who received surgical resection of the liver, no differences were found in overall survival, length of stay, or unplanned 30-day readmission rates between groups. Additional studies reporting survival rates in patients with intrahepatic cholangiocarcinoma or in mixed populations of patients with extrahepatic and intrahepatic cholangiocarcinoma have reported 5-year survival rates of less than 30%. The evidence is insufficient to determine the effects of the technology on health outcomes.

For individuals who have metastatic neuroendocrine tumors who receive a liver transplant, the evidence includes systematic reviews of case series. Relevant outcomes include overall survival, morbid events, and treatment-related morbidity and mortality. In select patients with nonresectable, hormonally active liver metastases refractory to medical therapy, liver transplantation has been considered as an option to extend survival and minimize endocrine symptoms. While some centers may perform liver transplants on select patients with neuroendocrine tumors, the available studies are limited by their heterogeneous populations. Further studies are needed to determine the appropriate selection criteria. The evidence is insufficient to determine the effects of the technology on health outcomes.

For individuals who have pediatric hepatoblastoma who receive a liver transplant, the evidence includes case series. Relevant outcomes include overall survival, morbid events, and treatment-related morbidity and mortality. The literature on liver transplantation for pediatric hepatoblastoma is limited, but case series have demonstrated good outcomes and high rates of long-term survival. Additionally, nonmetastatic pediatric hepatoblastoma is among in United Network for Organ Sharing criteria for patients eligible for liver transplantation. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome.

For individuals who have a failed liver transplant who receive a liver retransplant, the evidence includes observational studies. Relevant outcomes include overall survival, morbid events, and treatment-related morbidity and mortality. Case series have demonstrated favorable outcomes with liver retransplantation in certain populations, such as when criteria for an original liver transplantation are met for retransplantation. While some evidence has suggested outcomes after retransplantation may be less favorable than for initial transplantation in some patients, long-term survival benefits have been demonstrated. Las pruebas son suficientes para determinar que la tecnología da lugar a una mejora en el resultado neto para la salud.

For individuals with indications for liver and kidney transplant who receive a combined liver-kidney transplant (CLKT), the evidence includes a systematic review of retrospective observational studies in adults and several individual registry studies. Relevant outcomes include overall survival, morbid events, and treatment-related morbidity and mortality. Most of the evidence involves adults with cirrhosis and kidney failure. Indications for CLKT in children are rare and often congenital and include liver-based metabolic abnormalities affecting the kidney, along with structural diseases affecting both the liver and kidney. In both adults and children, comparisons with either liver or kidney transplantation alone suggest that CLKT is no worse, and possibly better, for graft and patient survival. Las pruebas son suficientes para determinar que la tecnología da lugar a una mejora en el resultado neto para la salud.

Definiciones

Albumin refers to one of a group of simple proteins widely distributed in plant and animal tissues. It is found in the blood as serum albumin, in milk as lactalbumin, and in egg white as ovalbumin.

Bilirubin refers to the orange-colored or yellowish pigment in the bile. It is derived from hemoglobin of red blood cells that have completed their life span and are destroyed and ingested by the macrophage system of the liver, spleen, and red bone marrow.

Blue Quality Centers for Transplant (BQCT) is a cooperative effort of the Blue Cross and Blue Shield Plans, the Blue Cross and Blue Shield Association, and participating medical institutions to provide patients who need transplants with access to leading centers through a coordinated, streamlined program of transplant management.

Cadaver refers to a dead body or corpse.

End-stage refers to the final phase of a disease process.

Extrahepatic refers to outside or unrelated to the liver.

Hepatocellular refers to the cells of the liver.

Macrovascular refers to the larger blood vessels in the body.

Prothrombin time is the time it takes for clotting to occur after prothromboplastin and calcium are added to decalcified plasma.

United Network of Organ Sharing (UNOS) is an organization established in 1984 to facilitate donation of organs for possible transplantation.

Exención de responsabilidad

Las políticas médicas de Capital Blue Cross se utilizan para determinar la cobertura de tecnologías, procedimientos, equipos y servicios médicos específicos. Estas políticas médicas no constituyen asesoramiento médico y están sujetas a cambios según lo exija la ley o las pruebas clínicas aplicables de las directrices de tratamiento independientes. Los proveedores que brindan tratamiento son individualmente responsables de los consejos médicos y el tratamiento de los miembros. Estas políticas no son una garantía de cobertura o pago. El pago de las reclamaciones está sujeto a la determinación del programa de beneficios del miembro y la elegibilidad en la fecha del servicio, y a la determinación de que los servicios son médicamente necesarios y apropiados. El procesamiento final de una reclamación se basa en los términos del contrato que se aplican al programa de beneficios de los miembros, incluidas las limitaciones y exclusiones de beneficios. Si un proveedor o miembro tiene alguna pregunta sobre esta política médica, debe comunicarse con Servicios para proveedores o Servicios para miembros de Capital Blue Cross.

Información de codificación

Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. La identificación de un código en esta sección no denota cobertura, ya que la cobertura está determinada por los términos de la información de beneficios del miembro. Además, no todos los servicios cubiertos son elegibles para un reembolso por separado.

Covered when medically necessary:

Referencias

1. Black CK, Termanini KM, Aguirre O, et al. Solid organ transplantation in the 21st century. Ann Transl Med. Oct 2018; 6(20): 409. PMID 30498736
2. Belle SH, Beringer KC, Detre KM. An update on liver transplantation in the United States: recipient characteristics and outcome. Clin Transpl. 1995: 19-33. PMID 8794252
3. Sheiner PA, Rosenthal RJ, Emre S, et al. Hepatitis C after liver transplantation. Mt Sinai J Med. Mar-Apr 2012; 79(2): 190-198. PMID 22499490
4. Gadiparthi C, Cholankeril G, Perumpail BJ, et al. Use of direct-acting antiviral agents in hepatitis C virus-infected liver transplant candidates. World J Gastroenterol. Jan 21, 2018; 24(3): 315-322. PMID 29391754
5. Wang X, Li J, Riaz DR, et al. Outcomes of liver transplantation for nonalcoholic steatohepatitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. Mar 2014; 12(3): 394-402.e1. PMID 24076414
6. Yong JL, Lim WH, Ng CH, et al. Outcomes of nonalcoholic steatohepatitis after liver transplantation: an updated meta-analysis and systematic review. Clin Gastroenterol Hepatol. Nov 18, 2021. PMID 34801743
7. Cholankeril G, Wong RJ, Hu M, et al. Liver Transplantation for Nonalcoholic Steatohepatitis in the US: Temporal Trends and Outcomes. Dig Dis Sci. Oct 2017; 62(10): 2915-2922. PMID 28744836
8. Schoenberg MB, Burcher JN, Vater A, et al. Resection or Transplant in Early Hepatocellular Carcinoma. Dtsch Arztebl Int. Aug 07 2017; 114(31-32): 519-526. PMID 28835324
9. Zheng Z, Liang W, Milgrom DP, et al. Liver transplantation versus liver resection in treatment of hepatocellular carcinoma: a meta-analysis of observational studies. Transplantation. Jan 27 2014; 97(2): 227-34. PMID 24142034
10. Guiteau JJ, Cotton RT, Washburn WK, et al. An early regional experience with expansion of Milan Criteria for liver transplant recipients. Am J Transplant. Sep 2010; 10(9): 2092-8. PMID 20883543
11. Pomfret EA, Washburn K, Wald C, et al. Report of a national conference on liver allocation in patients with hepatocellular carcinoma in the United States. Liver Transpl. Mar 2010; 16(3): 262-78. PMID 20209641
12. Ioannou GN, Perkins JD, Carithers RL. Liver transplantation for hepatocellular carcinoma: impact of the MELD allocation system and predictors of survival. Gastroenterology. May 2008; 134(5): 1342-51. PMID 18471571
13. Chan EY, Larson AM, Fix OK, et al. Identifying risk for recurrent hepatocellular carcinoma after liver transplantation: implications for surveillance studies and new adjuvant therapies. Liver Transpl. Jul 2008; 14(7): 956-65. PMID 18581511
14. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. Mar 14 1996; 334(11): 693-9. PMID 8594428
15. Firl DJ, Kimura S, McVey J, et al. Reframing the approach to patients with hepatocellular carcinoma: Longitudinal assessment with hazard associated with liver transplantation for HCC (HALT-HCC) improves ablate and wait strategy. Hepatology. Oct 2018; 68(4): 1448-1458. PMID 29604231
16. National Comprehensive Cancer Network. Hepatobiliary Cancers. Version 2.2024.
17. Yadav DK, Chen W, Bai X, et al. Salvage Liver Transplant versus Primary Liver Transplant for Patients with Hepatocellular Carcinoma. Ann Transplant. Aug 03 2018; 23: 524-545. PMID 30072683
18. Muralidharan V, Patil S, Phillips KT, et al. Locoregional Therapy With Curative Intent Versus Primary Liver Transplant for Hepatocellular Carcinoma: Systematic Review and Meta-Analysis. Transplantation. Aug 2017; 101(8): e249-e257. PMID 28282359
19. Maggs JR, Suddle AR, Aluvihare V, et al. Systematic review: the role of liver transplantation in the management of hepatocellular carcinoma. Aliment Pharmacol Ther. May 2012; 35(10): 1113-34. PMID 22432733
20. Chan DL, Azharin NA, Morris DL, et al. Systematic review of efficacy and outcomes of salvage liver transplantation after primary hepatic resection for hepatocellular carcinoma. J Gastroenterol Hepatol. Jan 2014; 29(1): 31-41. PMID 24117517
21. Zhu Y, Dong J, Wang WL, et al. Short- and long-term outcomes after salvage liver transplantation versus primary liver transplantation for hepatocellular carcinoma: a meta-analysis. Transplant Proc. Nov 2013; 45(9): 3329-42. PMID 24182812
22. Cambridge WA, Fairfield C, Powell JJ, et al. Meta-analysis and Meta-regression of Survival After Liver Transplantation for Unresectable Perihilar Cholangiocarcinoma. Ann Surg. Feb 01 2021; 273(2): 240-250. PMID 32097164
23. Gu J, Bai J, Shi X, et al. Efficacy and safety of liver transplantation in patients with cholangiocarcinoma: a systematic review and meta-analysis. Int J Cancer. May 01 2012; 130(9): 2155-63. PMID 21387295
24. Heimbach JK. Successful liver transplantation for hilar cholangiocarcinoma. Curr Opin Gastroenterol. May 2008; 24(3): 384-8. PMID 18408469
25. Darwish Murad S, Kim WR, Harnois DM, et al. Efficacy of neoadjuvant chemoradiation, followed by liver transplantation, for perihilar cholangiocarcinoma at 12 US centers. Gastroenterology. Jul 2012; 143(1): 88-98.e3; quiz e14. PMID 22554095
26. Heimbach JK, Gores GJ, Haddock MG, et al. Predictors of disease recurrence following neoadjuvant chemoradiotherapy and liver transplantation for unresectable perihilar cholangiocarcinoma. Transplantation. Dec 27 2006; 82(12): 1703-7. PMID 17198263
27. Rea DJ, Heimbach JK, Rosen CB, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg. Sep 2005; 242(3): 451-8; discussion 458-61. PMID 16135931
28. Pascher A, Jonas S, Neuhaus P. Intrahepatic cholangiocarcinoma: indication for transplantation. J Hepatobiliary Pancreat Surg. 2003; 10(4): 282-7. PMID 14598146
29. Friman S, Foss A, Isoniemi H, et al. Liver transplantation for cholangiocarcinoma: selection is essential for acceptable results. Scand J Gastroenterol. Mar 2011; 46(3): 370-5. PMID 21073376
30. Meyer CG, Penn I, James L. Liver transplantation for cholangiocarcinoma: results in 207 patients. Transplantation. Apr 27 2000; 69(8): 1633-7. PMID 10836374
31. Robles R, Figueras J, Turrion VS, et al. Spanish experience in liver transplantation for hilar and peripheral cholangiocarcinoma. Ann Surg. Feb 2004; 239(2): 265-71. PMID 14745336
32. Casavilla A, Marsh JW, Iwatsuki S, et al. Hepatic resection and transplantation for peripheral cholangiocarcinoma. J Am Coll Surg. Nov 1997; 185(5): 429-36. PMID 9358085
33. Ziogas IA, Giannis D, Economopoulos KP, et al. Liver Transplantation for Intrahepatic Cholangiocarcinoma: A Meta-analysis and Meta-regression of Survival Rates. Transplant Proc. Oct 2021; 105(10): 2263-2271. PMID 33196623
34. Hue JJ, Rocha FG, Armoin JB, et al. A comparison of surgical resection and liver transplantation in the treatment of intrahepatic cholangiocarcinoma in the era of modern chemotherapy: An analysis of the National Cancer Database. J Surg Oncol. Mar 2021; 123(4): 949-956. PMID 33400841
35. Palaniappan V, Li CH, Frilling A, et al. Long-Term Outcomes of Liver Transplantation for the Management of Neuroendocrine Neoplasms: A Systematic Review. J Pers Med. Sep 23 2023; 13(10). PMID 37888039
36. Fan ST, Le Treut YP, Mazzaferrro V, et al. Liver transplantation for neuroendocrine tumour liver metastases. HPB (Oxford). Jan 2015; 17(1): 23-8. PMID 24992381
37. Mathe Z, Takacs E, Paul A, et al. Liver transplantation for hepatic metastases of neuroendocrine pancreatic tumors: a survival-based analysis. Transplantation. Mar 15 2011; 91(5): 575-82. PMID 21200365
38. Hamilton EC, Balogh J, Nguyen DT, et al. Liver transplantation for primary hepatic malignancies of childhood: The UNOS experience. J Pediatr Surg. Oct 12 2017. PMID 29108844
39. Barrera S, Hernandez F, Miguel M, et al. High-risk hepatoblastoma: results in a pediatric liver transplantation center. Eur J Pediatr Surg. Jan 2011; 21(1): 18-20. PMID 20938901
40. Malek MM, Shah SR, Atri P, et al. Review of outcomes of primary liver cancers in children: our institutional experience with resection and transplantation. Surgery. Oct 2010; 148(4): 778-82; discussion 782-4. PMID 20728194
41. Browne M, Sher D, Grant D, et al. Survival after liver transplantation for hepatoblastoma: a 2-center experience. J Pediatr Surg. Nov 2008; 43(11): 1973-81. PMID 18970297
42. Czauderna P, Otte JB, Aronson DC, et al. Guidelines for surgical treatment of hepatoblastoma in the modern era-recommendations from the Childhood Liver Tumour Strategy Group of the International Society of Pediatric Oncology (SIOPEL). Eur J Cancer. May 2005; 41(7): 1031-6. PMID 15862752
43. Organ Procurement and Transplantation Network (OPTN). Policy 9: Allocation of livers and liver-intestines. Updated June 28, 2022.
44. Salimi J, Jafarian A, Fakhar N, et al. Study of re-transplantation and prognosis in a transplant center in Iran. Gastroenterol Hepatol Bed Bench. 2021; 14(3): 237-242. PMID 34221263
45. Bellini CB, Martin MJ, Antkowiak GS, et al. Have we changed the liver retransplantation survival? Transplant Proc. Jul-Aug 2012; 44(6): 1526-9. PMID 22841203
46. Remiszewski P, Kalinowski P, Dudek K, et al. Influence of selected factors on survival after liver retransplantation. Transplant Proc. Oct 2011; 43(8): 3025-8. PMID 21996216
47. Hong JC, Kaldas FM, Kositamongkol P, et al. Predictive index for long-term survival after retransplantation of the liver in adult recipients: analysis of a 26-year experience in a single center. Ann Surg. Sep 2011; 254(3): 444-8; discussion 448-9. PMID 21817890
48. Bouari S, Rijkse E, Metselaar HJ, et al. A comparison between combined liver kidney transplants to liver transplants alone: A systematic review and meta-analysis. Transplant Rev (Orlando). Dec 2021; 35(4): 100633. PMID 34098490
49. Lunsford KE, Bodzin AS, Markovic D, et al. Avoiding Simultaneous Liver-Kidney Transplantation: Analysis of 331 Consecutive Patients Listed for Dual Organ Replacement. Ann Surg. May 2017; 265(5): 1016-1024. PMID 27232249
50. Fong TL, Khemichian S, Shah T, et al. Combined liver-kidney transplantation is preferable to liver transplant alone for cirrhotic patients with renal failure. Transplantation. Aug 27 2012; 94(4): 411-6. PMID 22805440
51. Ruiz R, Jennings LW, Kim P, et al. Indications for combined liver and kidney transplantation: propositions after a 23-yr experience. Clin Transplant. Nov-Dec 2010; 24(6): 807-11. PMID 20002463
52. Calinescu AM, Wildhaber BE, Poncet A, et al. Outcomes of combined liver-kidney transplantation in children: analysis of the scientific registry of transplant recipients. Am J Transplant. Dec 2014; 14(12): 2861-8. PMID 25274400
53. de la Cerda JF, Jimenez WA, Gjerston DM, et al. Renal graft outcome after combined liver and kidney transplantation in children: UCLA and UNOS experience. Pediatr Transplant. Jun 2010; 14(4): 459-64. PMID 20070563
54. Marcos A, Ham JM, Fisher RA, et al. Single-center analysis of the first 40 adult-to-adult living donor liver transplants using the right lobe. Liver Transpl. May 2000; 6(3): 296-301. PMID 10827229
55. Malago M, Testa G, Marcos A, et al. Ethical considerations and rationale of adult-to-adult living donor liver transplantation. Liver Transpl. Oct 2001; 7(10): 921-7. PMID 11679994
56. Renz JF, Busuttil RW. Adult-to-adult living-donor liver transplantation: a critical analysis. Semin Liver Dis. 2002; 20(4): 411-24. PMID 11200412
57. Bak T, Wachs M, Trotter J, et al. Adult-to-adult living donor liver transplantation using right-lobe grafts: results and lessons learned from a single-center experience. Liver Transpl. Aug 2001; 7(8): 680-6. PMID 11510011
58. Shiffman ML, Brown RS, Olthoff KM, et al. Living donor liver transplantation: summary of a conference sponsored by the National Institutes of Health. Liver Transpl. Feb 2002; 8(2): 174-88. PMID 11862598
59. Grant RC, Sandhu L, Dixon PR, et al. Living vs. deceased donor liver transplantation for hepatocellular carcinoma: a systematic review and meta-analysis. Clin Transplant. Jan-Feb 2013; 27(1): 140-7. PMID 23157398
60. Tang W, Qiu JG, Cai Y, et al. Increased Surgical Complications but Improved Overall Survival with Adult Living Donor Compared to Deceased Donor Liver Transplantation: A Systematic Review and Meta-Analysis. Biomed Res Int. 2020; 2020: 1320830. PMID 32908865
61. Cooper C, Kanters S, Klein M, et al. Liver transplant outcomes in HIV-infected patients: a systematic review and meta-analysis with synthetic cohort. AIDS. Mar 27 2011; 25(6): 777-86. PMID 21412058
62. Terrault NA, Roland ME, Schiano T, et al. Outcomes of liver transplant recipients with hepatitis C and human immunodeficiency virus coinfection. Liver Transpl. Jun 2012; 18(6): 716-26. PMID 22328294
63. Organ Procurement and Transplantation Network (OPTN). Organ procurement and transplantation network policies. Updated June 28, 2022.
64. Blumberg EA, Rogers CC. Solid organ transplantation in the HIV-infected patient: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. Sep 2019; 33(9): e13499. PMID 30773688
65. Clavien PA, Lesurtel M, Bossuyt PM, et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. Jan 2012; 13(1): e11-22. PMID 22047762
66. American Association for the Study of Liver Diseases. American Society of Transplantation. Liver transplantation, evaluation of the adult patient. 2013.
67. Squires RH, Ng V, Romero R, et al. Evaluation of the pediatric patient for liver transplantation: 2014 practice guideline by the American Association for the Study of Liver Diseases, American Society of Transplantation and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. Hepatology. Jul 2014; 60(1): 362-98. PMID 24728219
68. American Association for the Study of Liver Diseases. Diagnosis and Treatment of Alcohol Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases.
69. Singal AG, Llovet JM, Yarchoan M, et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. May 22 2023. PMID 37199193
70. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine and Adrenal Tumors. Version 1.2022.
71. Centers for Medicare and Medicaid Services. National Coverage Determination (NCD) for Adult Liver Transplantation (260.1). 2012.
72. Centers for Medicare and Medicaid Services. National Coverage Determination (NCD) for Pediatric Liver Transplantation (260.2). 1991.
73. Scurt FG, Hammoud B, Bose K, Mertens PR, Chatzikyrkou C. Short-Term, Mid-Term, and Long-Term Outcomes after Deceased Donor Kidney Transplantation in Patients with AKI: A Systematic Review and Meta-Analysis. Kidney360. 2024; 5(7): 1012-1031. PMID 38668857