| Relative contraindications to pancreas-kidney transplantation |
| Age <18 or >60 years |
| BMI >30 to 35 kg/m2 |
| Daily insulin requirement >1 unit/kg |
| Insulin requiring for <3 years |
| Left ventricular ejection fraction <40% |
| Recent myocardial infarction or stroke |
| Pulmonary artery systolic pressure >50 mmHg (confirmed by right heart catheterization) |
| Active tobacco smoking (up to 1 pack/day or patient has mild smoking-related morbidities) |
| History of major unilateral or bilateral extremity amputations |
| Presence of aorto-iliac or aorto-bifemoral bypass graft |
| Symptomatic cerebrovascular or peripheral vascular disease |
| Positive thrombophilia screen or history of hypercoagulability |
| Peritoneal dialysis with history of multiple prior episodes of peritonitis |
| History of multiple previous laparotomies |
| History of previous intra-abdominal/pelvic irradiation or multiple surgical procedures |
| Severe or uncontrolled orthostasis or hypotension |
| Severe or uncontrolled gastroparesis |
| Presence of an ostomy, feeding tube, or chronic bladder drainage catheter |
| History of previous substance abuse, psychiatric illness, or noncompliance/nonadherence |
| Limited psychosocial support and resources (lives alone, relies on public transportation) |
| Jehovah's Witness who refuses blood products |
