Intestinal Transplantation

Aetna covers intestinal transplantation as medically necessary for patients with clinical indicators of failed TPN (e.g., recurrent severe dehydration despite IV fluids, ≥2 line‑related systemic sepsis/year or a single severe line‑related fungemia/septic shock/ARDS, TPN‑induced liver failure, or loss of vascular access) when strict selection criteria are met. Key requirements include no untreated active infection, adequate cardiovascular function (EF ≥40%), adequate liver/kidney function (bilirubin <2.5 mg/dL, creatinine clearance >50 ml/min/kg), psychiatric stability, and for HIV patients CD4 >200 cells/mm3 with undetectable viral load on stable ART >3 months; contraindications (advanced neurodegenerative disease, refractory CHF with EF <40%, untreated malignancy, multi‑organ failure, sepsis, unstable substance use) and multi‑visceral transplants for neuroendocrine pancreatic tumors, fecal calprotectin for rejection, and transplantation for recurrent non‑resectable pseudomyxoma peritonei are considered investigational or not medically necessary.