*Purpose: Weight gain is common following organ transplantation, and there exists concern that in simultaneous pancreas-kidney (SPK) recipients, this may lead to poorer graft outcomes.

*Methods: We reviewed data from 61 consecutive patients with type 1 diabetes mellitus who received SPK transplants between January 1^st, 2012, and December 31^st, 2017, to study excessive weight gain in these patients, and the subsequent effect on graft outcomes. Weight, and other outcomes were followed up until November 30^th, 2021. Excessive weight gain (EWG) was defined as an increase of > 20% in weight following transplant. Statistical analysis was performed with R.

*Results: Patient characteristics were as follows: 65% male, 67% Caucasian, 19% African American. At transplant, median age was 39 years, body mass index (BMI) was 24.08 kg/m². 29 patients (48%) experienced organ rejection (7 kidney rejection alone, 8 pancreas alone, 14 both organs). 14 patients (23%) experienced graft loss (5 pancreas alone, 3 kidney alone, 7 both organs). EWG at 1, 3, and 5 years occurred in 18%, 21%, and 13% of patients respectively. Univariate analysis showed that age at transplant, BMI at transplant, age <, or > 40 years, gender, race, rejection, and steroid use was not associated with excessive weight gain at 1 year post-transplant. At 3 years, African American race, and organ rejection were associated with EWG (p=0.019, and 0.05 respectively). At 5 years, only African American race was associated with EWG (p-=0.003). Of the variables studied, only organ rejection was associated with kidney and pancreas allograft loss, while other variables, including EWG at 1, 3, or 5 years were not. Mean BMIs at transplant, 1 year, 3 years and 5 years post-transplant were 24.1, 25.4, 26.0, 26.5 kg/m² respectively.

*Conclusions: At five years of follow-up, most patients did not have EWG. EWG did not increase the risk of graft loss.

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