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Should Reimbursement Be Denied for Liver Transplantation in Patients With Hepatocellular Carcinoma?

J. Wallis Marsh, MD; Igor Dvorchik, PhD; Adrian Casavilla, MD; John J. Fung, MD, PhD; Shunzaboro Iwatsuki, MD, PhD
JAMA. 1997;278(3):203-205. doi:10.1001/jama.1997.03550030043028.
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To the Editor.  —On July 15, 1996, the US Department of Health and Human Services expanded financial coverage of liver transplantation to all end-stage liver disease diagnoses except for hepatitis B or malignancies.1 Since the most common malignancy for which financial coverage of liver transplantation is offered is hepatocellular carcinoma (HCC), we reviewed our experience with patients receiving transplants in the presence of HCC to determine if this refusal of financial coverage for all patients with HCC is justifiable.Patients who received their first or subsequent liver transplant between January 1, 1981, and June 30, 1995, were eligible for inclusion in this study. In keeping with current Medicare guidelines, patients who were hepatitis B surface antigen (HBsAg)-positive as well as those whose HBsAg status was unknown were excluded, as were patients with any malignancy other than HCC. From the remaining patients, the 6 most common nonmalignant, HBsAg-negative diagnosis groups were selected


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