*Purpose: To assess the outcomes of simultaneous pancreas/kidney (SPK) transplantation in high and low BMI patients.

*Methods: A retrospective analysis of the United Network for Organ Sharing (UNOS) database was performed to identify SPK transplants between 1995 and 2018. Patients were divided according to preoperative BMI (<20, 20-35, and >35 kg/m²).

*Results: During the study period, 1628 patients with a BMI <20, 19505 with a BMI 20-35 and 269 with a BMI >35 underwent SPK transplantation. Their mean age was 37.6±9.1, 40.6±8.5, and 42.9±8.1 years, respectively. The rate of delayed kidney graft function was higher in the BMI >35 group (7.1, 7.8, and 13.7%, respectively, p<0.001). However, the rates of surgical site infection, anastomotic leak, and postoperative pancreatitis were similar between the groups. The 1-, 3-, and 5-year kidney graft survival rates were significantly higher in the BMI 20-35 group (1-year: 91.1, 99.2, and 86.2%; 3-year: 76.8, 84.0, and 71.0%; 5-year: 62.5, 69.2, and 56.1%, respectively; p<0.001). BMI did not significantly affect 1- and 3-year pancreatic graft survival; however, decreased 5-year survival was demonstrated in patient with BMI >35 (78.3, 64.7, and 46.9%, respectively, p=0.02).

*Conclusions: Although patient BMI does not affect post-SLK complication rates, long-term graft survival outcomes seem to be best in patients with a BMI 20-35. Preoperative weight optimization should be considered in this patient group.

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