*Purpose: In October 2014, United Network for Organ Sharing (UNOS) implemented criteria for simultaneous pancreas and kidney transplant (SPKT) in patients with c-peptide 2 > ng/mL that limits eligibility to lean candidates with a body mass index (BMI) ≤ 30 kg/m2. A recent public comment on this UNOS policy argues that there are no data to support such limitation.

*Methods: We examined Organ Procurement and Transplantation Network (OPTN) data for patients with type 2 diabetes mellitus (T2DM) who underwent a SPKT between January 2000 and December 2016, and were categorized based on standard BMI classifications: normal (18.5-24.9 kg/m², n = 281), overweight (25.0-29.9 kg/m², n = 377), and obese (30.0 ≥ kg/m², n = 113). Associations of transplant type with all cause graft failure and patient death (adjusted hazard ratio, 95% _LCL aHR 95% _UCL) were quantified by multivariate Cox regression including adjustment for recipient, donor, and transplant factors.

*Results: Compared to lean SPKT recipients (BMI 18.5-24.9 kg/m2), overweight recipients (25.0-29.9 kg/m2)had similar risk of pancreas (aHR _0.72 1.01 _1.43) or kidney failure (aHR.82 _0.56 0.82 _1.22) over the study period. Similarly, obese SPKT recipients did not have a higher pancreas (aHR _0.70 1.11 _1.77) or kidney failure (aHR _0.61 1.04 _1.78).

*Conclusions: Obese T2DM SPKT recipients have similar survival benefits to lean recipients. With the decrease of pancreas transplant nationwide, amending the UNOS policy may ultimately decrease the discard rate of pancreata and increase the number of SPKT while potentially improving the survival and quality of life for T2DM with renal failure.

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