*Purpose: Our aim was to study the concordance rate of kidney and pancreas rejection in patients who received simultaneous kidney-pancreas transplantation (SKP) and its effects on the long-term patient and graft survival.

*Methods: We retrospectively evaluated 317 SKP recipients at our center from July 2003 to March 2021. Our clinical protocol includes protocol biopsy at 4, and 12 months and prior to 2008, protocol biopsy was also done at 1-month post-transplant. We included the for-cause and protocol biopsy to look for the rejection rates including borderline rejection.

*Results: Median (IQR) follow-up was 7.03 (4.1,11.4) years. Mean age was 44.7 (27), mean diabetes mellitus duration was 27 (10) years with 59% males. We report the concordance between the kidney and pancreas biopsy. (Table 1). The average concordance between kidney and pancreas biopsy was between 50%-60%. When there was no rejection, the concordance rate was between 42%-58% and between 4%-12% when there was rejection in both organs during the one-year period. There were 34%-45% pancreas graft rejection without kidney rejection. Acute rejection of kidney within 1 year was associated with decreased both pancreas (log-rank 0.002) and kidney graft survival (log rank=0.038) but not patient survival (log-rank=0.6) Figure 1. Acute rejection of the pancreas was not associated with decreased survivals of any allograft or patient.

*Conclusions: There is approximately 40% discordance between acute kidney and pancreas rejection. Acute rejection of the kidney is associated with poor allograft functions.

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