Pancreas Transplantation Alone (PTA) and Islet Cell Transplantation

Aetna covers pancreas transplantation alone (PTA) for members who meet the transplanting center’s selection criteria and specified general/disease-specific requirements (no ongoing/recurrent untreated infections, documented compliance, controlled HIV with CD4>200 for >6 months, undetectable viral load and stable ART ≥3 months), and excludes PTA when cardiovascular risk is prohibitive (e.g., non‑correctable coronary disease, EF<35%, MI within 6 months) with listed relative contraindications (EF 35–40%, severe PVD, active substance use unless documented stability). Islet allotransplantation (Lantidra) is covered only for adults ≥18 with type 1 diabetes and recurrent severe hypoglycemia despite intensive management, requires concomitant immunosuppression, no prior renal transplant, a maximum of three infusions (repeat only if initial criteria persist and insulin independence not achieved/lost within one year), and ex‑situ pancreas perfusion, xenotransplantation, and PTA for longevity or lifestyle reasons are considered experimental/investigational.