*Purpose: Improved therapeutic advances in diabetes mellitus care have resulted in a higher number of older diabetics on dialysis. The majority of centers use an age cut-off of 50 years for Simultaneous Kidney Pancreas transplantation (SKP) due to the concern for poor graft survival and complications. The objective of this study was to compare the long-term outcomes of older (>50 years and <50 years) diabetic patients who received SKP transplant.

*Methods: We retrospectively evaluated 317 SKP transplant recipients at our center from July 2003 to March 2021.

*Results: There were 101(32%) subjects above 50 years and 216 (68%) subjects aged < 50years who received SKP. Median(IQR) follow-up was 7 (3.9,11) years. Table 1 provides differences in recipient and donor characteristics. Mean age was 56.5 in >50 years and 39 in the younger cohort(p<0.001). Duration of diabetes was higher in the older cohort (31.6 vs. 25, p<0.001). Donor characteristics were similar between the 2 groups. Incidence of delayed graft function, length of stay, readmission were similar. Serum creatinine, Hba1c, and C-peptide post-transplant were comparable (Table 2). Incidence of acute rejection of kidney and pancreas by 1-year (including the for cause, protocol biopsy, and borderline rejection) were also similar(Table 2). Estimated 3-year death censored pancreas (83% vs. 87%) and kidney graft survival (94% vs. 96%) were similar between the two cohorts. Patient survival was lower as expected but acceptable at 3 years in the older group (92% vs. 96.5%). Death censored pancreas (log-rank 0.67) and kidney survival (log-rank 0.43) were similar between the 2 groups.

*Conclusions: Subjects older than 50 years have similar pancreas and kidney graft survival compared to the younger cohort receiving SKP transplants.

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