*Purpose: Pancreas transplantation has been very effective in normalizing glucose control in type 1 diabetes and more recently in type 2 diabetes with equivalent patient and graft survival rates. However, the outcomes of SPK in overweight and obese recipients have not been specifically studied. Additionally, type 2 diabetics are often overweight, making them more susceptible to graft rejection, infections and surgical complications. We sought to investigate short term and long term outcomes of simultaneous kidney-pancreas transplantation (SKPT) in overweight and obese recipients

*Methods: Outcomes of SKPT from 1988-2017 in the United States were analyzed using ‘the United Network for Organ Sharing ‘(UNOS) database. All SKPT recipients were grouped into one of the four categories: overweight type 2 diabetics, normal weight type 2 diabetics, and overweight type 1 diabetics, with normal weight type 1 diabetics. In these groups of patients, causes of kidney and pancreas graft failure, graft survival times, and total deaths due to pancreas related complication, were compared to determine effects of BMI on post-transplant patient outcomes. Univariate analysis was performed utilizing Chi2 for categorical and Mann-Whitney U/Kruskal-Wallis as appropriate for continuous variables. Subset analysis was performed.

*Results: In the time period studied, 8,507 type 1 diabetic patients underwent SKPT of which 4,408 were overweight. While the most common cause for renal graft failure was chronic and acute rejection; in pancreas allografts it was allograft thrombosis (31%). In non-obese recipients, however the cause for graft loss is most commonly chronic rejection. There were a total of 1,165 graft failures due to rejection or surgical procedure in this overweight population : 469 kidney graft failures and 696 pancreas graft failures (28.5%). 874 (550 overweight, 324 normal weight) type 2 diabetic SKPTs were performed, and when analyzing the cause of kidney graft failure; recurrent diseases were only noticed in the overweight population, followed by primary failure and rejection. For pancreas graft failure, rejection and bleeding were noted in high frequency among overweight patients. Graft survival times were higher and percentage of deaths in relation to total patient population due to pancreas related complications were lower in the normal BMI population vs. overweight patients across both type 1 and type 2 diabetics.

*Conclusions: Overweight diabetic patients carry more risk of rejection and presence of surgical procedure complications than the non-overweight counterparts. Non-overweight patients also had longer graft survival times, and had less mortality due to pancreas related complications in both types of diabetes.

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