*Purpose: Simultaneous pancreas/kidney transplant (SPKT) is indicated for diabetic patients (pts) with chronic kidney disease and represents the largest proportion of pancreas transplants performed. Infection is a common complication post SPKT; however, etiologies and risk factors need further characterization.

*Methods: We performed a retrospective chart review of all pts who underwent an SPKT from 2015 – 2018 at our center. Pts demographics/outcomes, infection episodes, rejection episodes, and post-operative complications were collected for up to 180 days post SPKT. Fisher’s Exact test, Student’s T-Test and descriptive statistics were used.

*Results: 71 pts underwent SPKT during the observation period with the following characteristics: 58% male, mean age 43.5 years, mean length of stay (LOS) 8.5 days post SPKT, rate of return to OR in 30 days 16.9% (12/71), rejection rate of 25.4% (18/71), and mean readmission rate within 90 days 57.7% (41/71). 84.5% (60/71) of pts developed a total of 143 infection episodes within 180 days post SPKT and 65% (39/60) of those pts developed >1 infection episode. The mean time to onset of first infection was 55.3 days, with a median of 27.5 days for bacterial, 51 days for fungal, and 90 days for viral infection. The most common laboratory confirmed infections were as follows: 46.7% (28/60) bacterial, 11.7% (8/60) fungal, and 65.0% (39/60) viral. The most common sites of laboratory confirmed bacterial infections were urine (47.3%), blood stream (23.6%), and surgical site/organ space (14.6%). 12.7% (9/71) developed MDR infections (5.6% {4/71} with C. difficile). The most common fungus isolated was candida species; there was one episode of cryptococcal meningitis and one episode of invasive pulmonary aspergillosis identified. CMV infection occurred in 35.2% (25/71) of pts with a mean time from SPKT to CMV infection of 122 days. BKV viruria/viremia occurred in 36.6% (26/71) of pts with a mean time of 41 days post SPKT; 69.2% (18/26) of these pts had a reduction in immunosuppression. For patients with infections vs those without infection, there were no statistical differences with the following comparisons: kidney rejection (8% vs. 0%; p=1), dialysis post-transplant (12% vs 0%; p=0.59), pancreas rejection (18.3% vs 27.3% p=0.41), readmission within 90 days from initial transplant (62% vs 36%; p=0.184), return to OR within 30 days (18% vs 9%; p=0.68), or LOS after SPKT (8.5 vs 8.3 days; p=0.81). During 6 months of followup, overall patient survival was 97.2%; infection contributed to the cause of death in 2 pts.

*Conclusions: High rates of infection occur in SPKT recipients during the 6 month post transplant period, but despite this patient outcomes were favorable.

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