*Purpose: Surgical and immunosuppressive refinements have led to improved outcomes in simultaneous pancreas-kidney (SPK) transplants. Despite these improvements, early pancreas allograft loss remains not insignificant. Historic data has suggested that early pancreas loss correlates with reduced kidney allograft function. To investigate this further, we assessed the impact of early pancreas allograft failure on early and late kidney allograft outcomes in an updated cohort.

*Methods: 217 SPK recipients from 2006 to 2017 were identified at Mayo Clinic Arizona. Early pancreas allograft loss was defined as occurring within 30 days of transplant. Results were analyzed using chi-square, unequal variance t-tests and Kaplan-Meier survival analysis.

*Results: 27 SPK recipients had early pancreas allograft loss (12.4%). 4 pancreas allografts were lost between 30 days and 1 year of transplant (1.8%). Delayed graft function (DGF) was more common in recipients with early pancreas loss (22.2% vs. 7.4%, p=0.0239). There were 3 early (<30 days post-SPK) kidney allograft failures (1.4%); 1 occurred along with an early pancreas loss. No significant differences were observed in creatinine (p=0.5113) or eGFR (p=0.9125) at 30 days, 1 year and 2 years post-transplant (Figure 1). There were no statistically significant long term differences in patient survival (p=0.2543) or kidney allograft survival (p=0.7676) (Figure 2) although there was a trend towards decreased survival and kidney function beginning at 5 years post-transplant in the early pancreas loss cohort.

*Conclusions: Early pancreas allograft loss does not impact renal function at 1 and 2 years post-transplant. Improvements in clinical and surgical management, along with minimization of immunosuppression, are likely account for this finding as compared to older studies. A trend towards decreased patient survival and kidney allograft function was observed >5 years post-transplant in the early pancreas loss cohort which is consistent with older data. This trend can be predicted to be further minimized over time with the ongoing improvements in insulin therapy.

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