Medical policy: Kidney Transplants, Pancreas Transplants, and Simultaneous Kidney/Pancreas Transplants

Policy number: MP 9.005

Effective date: 2/1/2026

Policy

Kidney transplants

Kidney transplants with either a living or cadaver donor may be considered medically necessary for carefully selected candidates with end-stage renal disease.

Kidney retransplant after a failed primary kidney transplant may be considered medically necessary in individuals who meet criteria for kidney transplantation.

Kidney transplant is considered investigational for all other situations. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Policy guidelines for kidney transplants

Potential contraindications to solid organ transplant (subject to the judgment of the transplant center) include the following:

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

Renal-specific criteria

There are no medical criteria that must be met for an individual to be listed for a kidney transplant. Certain medical factors are utilized for calculating an individual's waiting time after being listed for a kidney transplant, which is used as a component of the kidney allocation system. These include the earliest date on which the registered candidate's glomerular filtration rate or measured or estimated creatinine clearance was less than or equal to 20 mL/min or regularly-administered dialysis was initiated for end-stage renal disease ; however, consideration for listing for renal transplant may start well before kidney function reaches this point, based on the anticipated time that an individual may spend on the waiting list.

Allogeneic pancreas transplant

A combined pancreas‑kidney transplant may be considered medically necessary in insulin‑dependent diabetic individuals with uremia.

Pancreas transplant after a prior kidney transplant may be considered medically necessary in individuals with insulin‑dependent diabetes.

Pancreas transplant alone may be considered medically necessary in individuals with severely disabling and potentially life‑threatening complications due to hypoglycemia unawareness and labile insulin‑dependent diabetes that persists in spite of optimal medical management.

Pancreas retransplant after a failed primary pancreas transplant may be considered medically necessary in individuals who meet criteria for pancreas transplantation.

Pancreas transplant is considered investigational in all other situations. There is insufficient evidence to support a general conclusion concerning the health outcomes or benefits associated with this procedure.

Policy guidelines for allogeneic pancreas transplant

General criteria

Potential contraindications for solid organ transplant are subject to the judgment of the transplant center and include the following:

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 kidney 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

Pancreas‑specific criteria

Candidates for pancreas transplant alone should additionally meet one of the following severity of illness criteria:

• Documentation of severe hypoglycemia unawareness as evidenced by chart notes or emergency room visits; or
• Documentation of potentially life‑threatening labile diabetes as evidenced by chart notes or hospitalization for diabetic ketoacidosis.

Additionally, most pancreas transplant individuals will have type 1 diabetes mellitus. In 2022, individuals with type 2 diabetes accounted for 22.4% of all pancreas transplants, according to data from the Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients.

Multiple transplant criteria

Although there are no standard guidelines regarding multiple pancreas transplants, the following information may aid in case review:

• If there is early graft loss resulting from technical factors (e.g., venous thrombosis), a retransplant may generally be performed without substantial additional risk.
• Long-term graft losses may result from chronic rejection, which is associated with increased risk of infection following long-term immunosuppression and sensitization, which increases the difficulty of finding a negative cross-match. Some transplant centers may wait to allow reconstitution of the immune system before initiating retransplant with an augmented immunosuppression protocol.

Cross-references:

• MP 9.012 Islet Transplantation

Product variations

This policy is only applicable to certain programs and products administered by Capital Blue Cross and subject to benefit variations. Please see additional information below.

FEP PPO - Refer to FEP Medical Policy Manual.

Description/Background

Kidney transplant

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 the Organ Procurement and Transplantation Network (OPTN) and United Network of Organ Sharing (UNOS).

Kidney transplant

In 2024, 48,149 transplants were performed in the United States procured from 41,119 deceased donors and 7,030 living donors. Kidney transplants were the most common procedure with 27,759 transplants performed from both deceased and living donors in 2024. Since 1988, the cumulative number of kidney transplants is 609,382. Of the cumulative total, 69% of the kidneys came from deceased donors and 31% from living donors.

Kidney transplant, using kidneys from deceased or living donors, is an accepted treatment of end-stage renal disease (ESRD). ESRD refers to the inability of the kidneys to perform their functions (i.e., filtering wastes and excess fluids from the blood). ESRD, which is life-threatening, is also known as chronic kidney disease stage 5 and is defined as a glomerular filtration rate (GFR) less than or equal to 15 mL/min/1.73 m2. Patients with advanced chronic kidney disease, mainly stage 4 (GFR 15 to 29 mL/min/1.73 m2), should be evaluated for transplant. Being on dialysis is not a requirement to be considered for kidney transplant. Severe non-compliance and substance abuse serve as contraindications to kidney transplantation, but even those could be overcome with clinician support and patient motivation. All kidney transplant candidates receive organ allocation points based on waiting time, age, donor-recipient immune system compatibility, prior living donor status, distance from donor hospital, and survival benefit.

Combined kidney and pancreas transplants and management of acute rejection of kidney transplant using either intravenous immunoglobulin or plasmapheresis are discussed in separate evidence reviews.

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.

Allogeneic pancreas transplant

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 the Organ Procurement and Transplantation Network (OPTN) and United Network of Organ Sharing.

Allogeneic pancreas transplant

In 2023, 46,630 transplants were performed in the United States procured from more than 16,000 deceased donors and 6,900 living donors. Pancreas-kidney transplants were the fifth most common procedure, with 812 transplants performed in 2023. Pancreas-alone transplants were the sixth most common procedure, with 102 transplants performed in 2023.

Pancreas transplantation occurs in several different scenarios such as (1) a diabetic patient with renal failure who may receive a simultaneous cadaveric pancreas plus kidney transplant; (2) a diabetic patient who may receive a cadaveric or living-related pancreas transplant after a kidney transplantation (pancreas after kidney); or (3) a nonuremic diabetic patient with specific severely disabling and potentially life-threatening diabetic problems who may receive a pancreas transplant alone.

Data from the United Network for Organ Sharing and the International Pancreas Transplant Registry indicate that the proportion of simultaneous pancreas plus kidney transplant recipients worldwide who have type 2 diabetes has increased over time, from 6% of transplants between 2005 and 2009 to 9% of transplants between 2010 and 2014. Between 2010 and 2014, approximately 4% of pancreas after kidney transplants and 4% of pancreas alone transplants were performed in patients with type 2 diabetes. In 2022, patients with type 2 diabetes accounted for 22.4% of all pancreas transplants, according to data from the Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients.

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.

Rationale

Kidney transplant

Summary of evidence

For individuals who have end-stage renal disease without contraindications to kidney transplant who receive a kidney transplant from a living donor or deceased (cadaveric) donor, the evidence includes registry data and case series. Relevant outcomes are overall survival, morbid events, and treatment-related mortality and morbidity. Data from large registries have demonstrated reasonably high survival rates after kidney transplant for appropriately selected patients and significantly higher survival rates for patients undergoing kidney transplant compared with those who remained on a waiting list. Kidney transplantation is contraindicated for patients in whom the procedure is expected to be futile due to comorbid disease or in whom post-transplantation care is expected to significantly worsen comorbid conditions. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have a failed kidney transplant without contraindications to kidney transplant who receive a kidney retransplant from a living donor or deceased (cadaveric) donor, the evidence includes registry data and case series. Relevant outcomes are overall survival, morbid events, and treatment-related mortality and morbidity. Data have demonstrated reasonably high survival rates after kidney retransplantation (e.g., 5-year survival rates ranging from 87% to 96%) for appropriately selected patients. Kidney retransplantation is contraindicated for patients for whom the procedure is expected to be futile due to comorbid disease or for whom posttransplantation care is expected to significantly worsen comorbid conditions. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcome.

Allogeneic pancreas transplant

Summary of evidence

For individuals who have insulin-dependent diabetes who receive a pancreas transplant after a kidney transplant, the evidence includes retrospective studies and registry studies. Relevant outcomes are overall survival, change in disease status, and treatment-related mortality and morbidity. Data from national and international registries have found relatively high patient survival rates with a pancreas transplant after a kidney transplant (e.g., a 3-year survival rate of 94.5%). Single-center retrospective studies have found similar patient survival and death-censored pancreas graft survival rates with a pancreas transplant after a kidney transplant or a simultaneous pancreas and kidney (SPK) transplant. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have insulin-dependent diabetes with uremia who receive SPK transplants, the evidence includes retrospective studies and registry studies. Relevant outcomes are overall survival, change in disease status, and treatment-related mortality and morbidity. Data from national and international registries have found relatively high patient survival rates after SPK transplant. A retrospective analysis found a higher survival rate in patients with type 1 diabetes who had an SPK transplant versus those on a waiting list. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have insulin-dependent diabetes and severe complications who receive pancreas transplant alone, the evidence includes registry studies. Relevant outcomes are overall survival, change in disease status, and treatment-related mortality and morbidity. Data from international and national registries have found that graft and patient survival rates after pancreas transplant alone have improved over time (e.g., 3-year survival of 94.9%). The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.

For individuals who have had a prior pancreas transplant who still meet criteria for a pancreas transplant who receive pancreas retransplantation, the evidence includes retrospective studies and registry studies. Relevant outcomes are OS, change in disease status, and treatment-related mortality and morbidity. National data and specific transplant center data have generally found similar graft and patient survival rates after pancreas retransplantation compared with initial transplantation. The evidence is sufficient to determine that the technology results in an improvement in the net health outcome.

Definitions

Absolute contraindication is a reason for not performing a particular therapeutic intervention which is so compelling or carries such a grave risk that its performance would be reasonably regarded as constituting malpractice.

Blue Distinction Centers for Transplant (BDCT) 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 renal disease (ESRD) is a point at which the kidney is so badly damaged or scarred that hemodialysis or transplantation is required for patient survival.

Immunosuppressive refers to any treatment used to block abnormal or excessive immune responses.

Insulin is a hormone secreted by the beta cells of the pancreas that controls the metabolism and cellular uptake of sugars, proteins, and fat.

Relative contraindication is a condition which makes a particular treatment or procedure somewhat inadvisable but does not rule it out.

Uremic pertains to a toxic level of urea (nitrogenous waste) in the blood.

Disclaimer

Capital Blue Cross’ medical policies are used to determine coverage for specific medical technologies, procedures, equipment, and services. These medical policies do not constitute medical advice and are subject to change as required by law or applicable clinical evidence from independent treatment guidelines. Treating providers are solely responsible for medical advice and treatment of members. These policies are not a guarantee of coverage or payment. Payment of claims is subject to a determination regarding the member’s benefit program and eligibility on the date of service, and a determination that the services are medically necessary and appropriate. Final processing of a claim is based upon the terms of contract that applies to the member’s benefit program, including benefit limitations and exclusions. If a provider or a member has a question concerning this medical policy, please contact Capital Blue Cross’ Provider Services or Member Services.

Coding information

Note: This list of codes may not be all-inclusive, and codes are subject to change at any time. The identification of a code in this section does not denote coverage as coverage is determined by the terms of member benefit information. In addition, not all covered services are eligible for separate reimbursement.

Covered when medically necessary:

References

Kidney transplant

1. Black CK, Termanini KM, Aguirre O, et al. Solid organ transplantation in the 21 st century. Ann Transl Med. Oct 2018; 6(20): 409. PMID 30498736
2. Organ Procurement and Transplantation Network. National data. May 31, 2025. https://optn.transplant.hrsa.gov/data/view-data-reports/. Accessed June 17, 2025.
3. National Kidney Foundation. Glomerular Filtration Rate (GFR). 2022. https://www.kidney.org/atoz/content/gfr. Accessed June 17, 2025.
4. U.S. Department of Health & Human Services. Educational guidance on patient referral to kidney transplantation. September 2015. https://optn.transplant.hrsa.gov/resources/guidance/educational-guidance-on-patient-referral-to-kidney-transplantation/. Accessed June 17, 2025.
5. United Network for Organ Sharing (UNOS). How we match organs. 2025. https://unos.org/transplant/how-we-match-organs/. Accessed June 16, 2025.
6. Chaudhry P, Chaudhry A, Peracha J, et al. Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: systematic review and meta-analysis. BMJ. Mar 01 2022; 376: e068769. PMID 35232772
7. Krishnan N, Higgins R, Short A, et al. Kidney transplantation significantly improves patient and graft survival irrespective of BMI: a cohort study. Am J Transplant. Sep 2015; 15(9): 2378–2386. PMID 26147285
8. Querard AH, Foucher Y, Combescure C, et al. Comparison of survival outcomes between expanded criteria donor and standard criteria donor kidney transplant recipients: a systematic review and meta-analysis. Transpl Int. Apr 2016; 29(4): 403–415. PMID 26756928
9. Pestana JM. Clinical outcomes of 11,436 kidney transplants performed in a single center. Hosp Pract (1995). Jan 2017; 39(3): 287–295. PMID 28902233
10. Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA. Mar 10 2010; 303(10): 959–966. PMID 20215610
11. Durand CM, Massie A, Forman S, et al. Safety of kidney transplantation from donors with HIV. N Engl J Med. Oct 13 2022; 391(15): 1390–1401. PMID 39413376
12. Locke JE, Reed RD, Mehta SG, et al. Center-level experience and kidney transplant outcomes in HIV-infected recipients. Am J Transplant. Aug 2015; 15(8): 2096–2104. PMID 25773499
13. Locke JE, Mehta S, Reed RD, et al. A national study of outcomes among HIV-infected kidney transplant recipients. J Am Soc Nephrol. Sep 2015; 26(9): 2222–2229. PMID 25791727
14. Locke JE, Gustafson S, Mehta S, et al. Survival benefit of kidney transplantation in HIV-infected patients. Am Surg. Mar 2017; 263(3): 604–608. PMID 27768822
15. Sawinski D, Forde KA, Eddinger K, et al. Superior outcomes in HIV-positive kidney transplant patients compared with HCV-infected or HIV/HCV-coinfected recipients. Kidney Int. Aug 2015; 88(2): 341–349. PMID 25807035
16. Zheng X, Gong L, Xue W, et al. Kidney transplant outcomes in HIV-positive patients: a systematic review and meta-analysis. AIDS Res Ther. Nov 20 2019; 16(1): 37. PMID 31747972
17. Organ Procurement and Transplantation Network (OPTN). OPTN policies. Updated March 27, 2025. https://optn.transplant.hrsa.gov/policies/bylaws/policies/. Accessed June 15, 2025.
18. Working Party of the British Transplantation Society. Kidney and pancreas transplantation in patients with HIV. Second edition (revised). 2017. https://bts.org.uk/wp-content/uploads/2017/04/02_BTS_Kidney_Pancreas_HIV.pdf. Accessed June 17, 2025.
19. Fabrizi F, Martin P, Dixit V, et al. Meta-analysis of observational studies: hepatitis C and survival after renal transplant. J Viral Hepat. May 2014; 21(5): 314-324. PMID 24716634
20. Gill JS, Lan J, Dong J, et al. The survival benefit of kidney transplantation in obese patients. Am J Transplant. Aug 2013; 13(8): 2083-2090. PMID 23890325
21. Pieloch D, Dombrovsky V, Osband AJ, et al. Morbid obesity is not an independent predictor of graft failure or patient mortality after kidney transplantation. J Ren Nutr. Jan 2014; 24(1): 50-57. PMID 24070588
22. Kwan JM, Hajjir Z, Metwally A, et al. Effect of the obesity epidemic on kidney transplantation: obesity is independent of diabetes as a risk factor for adverse renal transplant outcomes. PLoS One. 2016; 11(11): e0165712. PMID 27851743
23. Kervinen MH, Lehto S, Helve J, et al. Type 1 diabetic patients on renal replacement therapy: probability to receive renal transplantation and survival after transplantation. PLoS One. 2018; 13(8): e0201478. PMID 30110346
24. Lim WH, Wong G, Pilmore HL, et al. Long-term outcomes of kidney transplantation in people with type 2 diabetes: a population cohort study. Lancet Diabetes Endocrinol. Jan 2017; 5(1): 26-33. PMID 28017085
25. Barocci S, Valente U, Fontana I, et al. Long-term outcome on kidney retransplantation: a review of 100 cases from a single center. Transplant Proc. May 2009; 41(4): 1156-1158. PMID 19460504
26. Kainz A, Kammer M, Reindl-Schwaighofer R, et al. Waiting time for second kidney transplantation and mortality. Clin J Am Soc Nephrol. Jan 2022; 17(1): 90-97. PMID 34965955
27. Gupta M, Wood A, Mitra N, et al. Repeat kidney transplantation after failed first transplantation: past performance informs future performance. Transplantation. Aug 2015; 99(8): 1700-1708. PMID 25803500
28. Shelton BA, Mehta S, Sawinski D, et al. Increased mortality and graft loss with kidney retransplantation among human immunodeficiency virus (HIV)-infected recipients. Am J Transplant. Jan 2017; 17(1): 173-179. PMID 27305590
29. American Society of Transplant Surgeons (ASTS), The American Society of Transplantation (AST), The Association of Organ Procurement Organizations (AOPO), et al. Statement on transplantation of organs from HIV-infected deceased donors. 2011. https://asts.org/docs/default-source/position-statements/transplantation-of-organs-from-hiv-infected-deceased-donors-july-22-2011.pdf. Accessed June 17, 2025.
30. Centers for Medicare & Medicaid Services. Medicarens-and-Guidance/Guidance/Manuals/Downloads/bp102c11.pdfhttps://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c11.pdf. Accessed June 17, 2025.

Allogeneic pancreas transplant

1. Kandaswamy R, Stock PG, Miller JM, et al. OPTN/SRTR 2022 Annual Data Report: Pancreas. Am J Transplant. Feb 2024; 24(2S1): S119-S175. PMID 38431358
2. 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
3. United Network for Organ Sharing (UNOS). Transplant trends. 2024. https://unos.org/data/. Accessed June 24, 2024.
4. Gruessner AC, Gruessner RW. Pancreas transplantation of US and non-US cases from 2005 to 2014 as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud. 2016; 13(1): 35-58. PMID 26928345
5. Parajuli S, Arashan AH, Swanson KJ, et al. Outcomes after simultaneous kidney-pancreas versus pancreas after kidney transplantation in the current era. Clin Transplant. Dec 2019; 33(12): e13732. PMID 31628870
6. Bazarbachi F, Selzner M, Marquez MA, et al. Pancreas-after-kidney versus synchronous pancreas-kidney transplantation: comparison of intermediate-term results. Transplantation. Feb 15 2013; 95(3): 489-494. PMID 23183776
7. Fridell JA, Mangus RS, Hollinger EF, et al. The case for pancreas after kidney transplantation. Clin Transplant. 2009; 23(4): 447-453. PMID 19453642
8. Keinlauss F, Fauda M, Sutherland DE, et al. Pancreas transplant in diabetic patients: impact on long-term kidney graft function. Clin Transplant. 2009; 23(4): 437-446. PMID 19496790
9. Organ Procurement and Transplantation Network (OPTN). National data. n.d. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/. Accessed June 24, 2024.
10. Barlow AD, Saeb-Parsy K, Watson CJE. An analysis of the survival outcomes of simultaneous pancreas and kidney transplantation compared to live donor kidney transplantation in patients with type 1 diabetes: a UK Transplant Registry study. Transplant Int. Sep 2017; 30(9): 884-892. PMID 28319322
11. van Dellen D, Worthington J, Mitu-Preziam OM, et al. Mortality in diabetes: pancreas transplantation is associated with significant survival benefit. Nephrol Dial Transplant. May 2013; 28(5): 1315-1322. PMID 23512107
12. Sampaio MS, Kuo HT, Bunnapradist S. Outcomes of simultaneous pancreas-kidney transplantation in type 2 diabetic recipients. Clin J Am Soc Nephrol. May 2011; 6(5): 1198-1206. PMID 21441123
13. Pugliese A, Reijonen HK, Nepom J, et al. Recurrence of autoimmunity in pancreas transplant patients: research update. Diabetes Manag (Lond). Mar 2011; 1(2): 229-238. PMID 21927622
14. Gruessner AC. 2011 update on pancreas transplantation: comprehensive trend analysis of 25,000 cases followed over the course of twenty-four years at the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud. 2011; 8(1): 6-16. PMID 21720668
15. Boggi U, Baronti W, Amores G, et al. Treating type 1 diabetes by pancreas transplant alone: a cohort study on actual long-term (10 years) efficacy and safety. Transplantation. Jan 01 2022; 106(1): 147-157. PMID 33909390
16. Scalea JR, Butler CC, Munivenkatappa RB, et al. Pancreas transplant alone as an independent risk factor for the development of renal failure: a retrospective study. Transplantation. Dec 27 2008; 86(12): 1789-94. PMID 19104423
17. Parajuli S, Arunachalam A, Swanson KJ, et al. Pancreas retransplant after pancreas graft failure in simultaneous pancreas-kidney transplants is associated with better kidney graft survival. Transplant Direct. Aug 2019; 5(8): e473. PMID 31576369
18. Gasteiger S, Cardini B, Göbel G, et al. Outcomes of pancreas retransplantation in patients with pancreas graft failure. BJSurg. Dec 2018; 105(13): 1816-1824. PMID 30007018
19. Buron F, Thaunat O, Demuylder-Mischler S, et al. Pancreas retransplantation: a second chance to diabetic patients? Transplantation. Jan 27 2013; 95(2): 347-52. PMID 23222920
20. Fridell JA, Mangus RS, Chen JM, et al. Late pancreas retransplantation. Clin Transplant. Jan 2015; 29(1): 1-8. PMID 25284041
21. Seal J, Selzner M, Laurence J, et al. Outcomes of pancreas retransplantation after simultaneous kidney-pancreas transplantation are comparable to pancreas after kidney transplantation alone. Transplantation. Mar 2015; 99(3): 623-8. PMID 25148379
22. Rudolph EN, Finger EB, Chandolias N, et al. Outcomes of pancreas retransplantation. Transplantation. Feb 2015; 99(2): 367-74. PMID 25594555
23. Organ Procurement and Transplantation Network (OPTN). OPTN policies. Updated May 29, 2024. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf. Accessed June 25, 2024.
24. 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
25. Siskind E, Maloney C, Ackerman M, et al. An analysis of pancreas transplantation outcomes based on age from the UNOS database. Clin Transplant. Sep 2014; 28(9): 990-4. PMID 24954116
26. Shah AP, Mangus RS, Powleson JA, et al. Impact of recipient age on whole organ pancreas transplantation. Clin Transplant. 2013; 27(1): E49-55. PMID 23228216
27. Afaneh C, Rich BS, Aull MJ, et al. Pancreas transplantation: does age increase morbidity? J Transplant. 2011; 2011: 596801. PMID 21766001
28. Schenker P, Vonend O, Krüger B, et al. Long-term results of pancreas transplantation in patients older than 50 years. Transpl Int. Feb 2011; 24(2): 136-42. PMID 21039944
29. Gruessner AC, Sutherland DE. Access to pancreas transplantation should not be restricted because of age: invited commentary on Schenker et al. Transpl Int. Feb 2011; 24(2): 134-5. PMID 21028293
30. Centers for Medicare & Medicaid Services (CMS). Transplant. 2023. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandCompliance/Transplant. Accessed June 24, 2024.
31. Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD) for Pancreas Transplants (260.3). 2000. https://www.cms.gov/medicare-coverage