*Purpose: Simultaneous pancreas and kidney (SPK) or pancreas after kidney (PAK) transplant are potential options for diabetic ESRD patients. Historically, PAK pancreas graft outcomes were felt to be inferior to those of SPK pancreas graft outcomes. Little is known about outcomes in the modern era of transplantation.

*Methods: We analyzed our primary SPK and PAK recipients transplanted between 01/2000 and 12/2016.

*Results: There were a total of 635 pancreas and kidney transplant recipients during the study period, 611 SPK and 24 PAK. 12 of the PAK patients received a living donor kidney and 12 received a deceased donor kidney. The majority of patients in both groups were male and Caucasian. Mean wait time to receive the first organ was significantly shorter in SPK, 184 ± 10 days compared to 451 ± 54 days in PAK (p=0.02). There were no significant differences between the two groups in kidney or pancreas graft rejection at one year. Similarly, one-year graft survival for both organs was not different between the groups. At last follow up, uncensored and death-censored (figure 1) graft survival were not statistically different for kidney or pancreas grafts. Similarly, comparing living donor kidney or deceased donor in PAK with SPK, there were no significant differences in survival of either graft.

*Conclusions: Although the majority of pancreas transplants are in the form of SPK, PAK is an acceptable alternative. SPK may be better in regions with short wait time, but PAK, with living donor kidney may be an altenrative in regions with long SPK wait times.

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