Outcomes and survival benefit of simultaneous pancreas kidney transplantation (SPKT) of older donor organs into older recipients has not been studied. SRTR data reported for SPKT recipients between 2000-2009 were stratified by donor and recipient age (cut-off 45 years) into: young-to-young (n=5339), old-to-young (n=388), young-to-old (n=2773), and old-to-old (n=282). Outcomes were compared using multivariable regression models. Another cohort of old SPKT candidates receiving dialysis wait-listed between 1993-2008 were analyzed for mortality risk after SPKT using old organs compared with a combined standard-therapy group of SPKT using young organs and those still receiving dialysis. Old-to-old SPKT was associated with significantly higher overall risk of pancreas graft failure (aHR 1.86, 95%CI 1.47, 2.35), kidney graft failure (aHR 1.71, 95%CI 1.31, 2.23) and patient death (aHR 1.73, 95%CI 1.27, 2.35) (Figure 1) compared to young-to-old. The mean waiting time of old-to-old (n= 131, 319 ± 285 days) was similar to that of young-to-old SPKT patients (n=1201, 320±314 days, p 0.9747). The adjusted overall relative mortality risk was not significantly different for old recipients of old-SPKT compared with those receiving standard therapy (aRR 1.05, 95%CI 0.74, 1.48). Old-to-old SPKT results in significantly worse pancreas and renal graft survival and patient mortality without any waiting time benefit.

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