Pediatric Liver Transplant

This policy covers pediatric liver transplantation for members under age 18 with end‑stage liver disease or acute liver failure who meet specified transplant criteria (for example, life expectancy ≤18 months without transplant, unacceptable quality of life or growth/neurodevelopmental impairment, and etiologies such as biliary atresia, FIC1, primary sclerosing cholangitis, Alagille syndrome, recurrent cholangitis, or liver‑based coagulopathy). Transplants are limited to candidates who meet medical and psychosocial requirements and exclude adults and those with uncontrolled/highly virulent infections, uncontrolled HIV without suppression (CD4 >200 and on ART required), malignancies with high recurrence risk, severe comorbidities (e.g., GFR <30 unless multi‑organ transplant, refractory portopulmonary hypertension), active substance use without documented risk‑reduction, or inadequate social support/inability to adhere to post‑transplant care.

"Pediatric members/enrollees (age < 18) with end-stage liver disease who meet all of the policy's specified transplant criteria."