|
6.3.42.6.3 Pancreas Transplant Alone
For a transplant of the pancreas alone, documentation must be submitted that shows all of the following:
• A satisfactory kidney function (creatinine clearance greater than 40 mL/min)
•Type 1 diabetes with secondary diabetic complications that are progressive despite the best medical management and meet at least one of the following below:
•Secondary complications which must include at least two of the following:
•Diabetic neuropathy
•Retinopathy
•Gastroparesis
•Autonomic neuropathy
•Extremely labile (brittle) insulin-dependent diabetes melliltus
•Recurrent, acute and severe metabolic and potentially life-threatening complications requiring medical attention, which include:
•Hypoglycemia.
•Hyperglycemia.
•Ketacidosis.
•Failure of exogenous insulin-based management to achieve sufficient glycemic control (HbA1c of greater than 8.0) despite aggressive conventional therapy.
•Insensibility to hypoglycemia.
|
