*Purpose: Combined kidney-pancreas transplant remains an optimal choice for type 1 diabetics with kidney failure. The benefit for those with type 2 diabetes, however, remains less well established. The objective of this study was to compare SKP outcomes in type 1 (DM-1) and 2 diabetics (DM-2). Type I was defined as unmeasurable C-peptide levels.

*Methods: We retrospectively evaluated 317 deceased SKP transplant recipients at our center from July 2003 to March 2021. Pancreas graft loss was defined as requiring insulin for more than 90 days or graft removal.

*Results: 66 (21%) SKP recipients had DM-2 and 251 (79%) had DM-1. Median (IQR) follow-up was 7 (3.9,11) years. Table 1 provides the difference in recipient and donor characteristics. Recipients with DM-2 were older (p=.02), more likely to be male (p=.046), and more likely to be on dialysis at the time of SKP (p=.02). There were no differences in BMI between the 2 groups (p=0.6). Donor characteristics were similar between the 2 groups. There was one recipient in DM-2 who needed oral DM medication due to weight gain. Serum creatinine and C-peptide were comparable at 3 years between the groups. (Table 2) Incidence of acute (including borderline) rejection of kidney and pancreas within 1 year (including the for-cause and protocol biopsy) were similar between the 2 cohorts. (Table 2)Estimated 3-year death censored pancreas (84% vs. 87%, p= 0.48), kidney graft survival (95% vs. 96.5%, p=0.36) and patient survival (94% vs. 96%, p=0.49) were comparable between the type 2 vs. type 1 diabetics.

*Conclusions: Carefully selected SKP recipients with DM-2 have similar graft survival compared to those with DM-1. Outcome data pertaining to the benefit of SKP in higher BMI patients with DM-2 remains limited.

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