*Purpose: Cardiovascular disease is the main cause of death in patients with type 1 diabetes mellitus (DM1). Information available about the impact of simultaneous pancreas-kidney transplantation (SPKT) on these patients is limited. The objective of the present study was to identify if there is a post-transplant cardiovascular risk modification, compared with the calculated pre-transplant one according to the Steno T1 Risk Score.

*Methods: We carried out a retrospective study performed with patients with DM1 and end-stage renal disease (ESRD) referred for SPKT evaluation between 1999 and 2017. Pretransplant cardiovascular risk factors, cardiovascular events (CVE) before and after SPKT (peripheral vascular disease, cerebrovascular disease, coronary arterial disease) and CVE calculated risk at 5 and 10 years by Steno T1 scale at the time of transplantation was assessed.

*Results: We included 249 SPKT recipients (65.5% males), with a mean age of 38.4±7.0 years, with a mean follow-up of 98±59 months. 39.6% had presented some pre-transplant CVE. According to the Steno scale, at the time of the SPKT CVE risk at 5 and 10 years was 31±12% and 57±17%, respectively. 47 patients (19.5%) presented some post-transplant CVE, with an average time from transplant to the event of 7.5±5.0 years. CVE-free survival estimated by Kaplan-Meier at 5 and 10 years was 90.8% and 77.7%, respectively. The risk of post-transplant CVE was significantly lower than that estimated by Steno scale (at 5 years 10% vs 31%, at 10 years 25 vs 56%, respectively). The main risk factor for post-transplant CVE was previous pre-transplant CVE (16 vs 25% post-transplant events, respectively, HR 1.76, 95% CI 1.005-3.008).

*Conclusions: SPKT decreases the risk of CVE at 5 and 10 years compared to that estimated by the Steno T1 validated scale. A significant risk factor for presenting a post-transplant CVE was the presence of pre-transplant CVE.

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