Relative contraindications include age > 55 and significant atherosclerotic cardiovascular disease, defined as a previous myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention, or a positive stress test; these factors dramatically increase perioperative risk. Options include Simultaneous pancreas-kidney (SPK) transplantation Pancreas-after-kidney (PAK) transplantation Pancreas-alone transplantation The advantages of simultaneous pancreas-kidney transplantation are one-time exposure to induction immunosuppression, potential protection of the newly transplanted kidney from adverse effects of hyperglycemia, and the ability to monitor rejection in the kidney; the kidney is more prone to rejection than the pancreas, where rejection is difficult to detect.