*Purpose: To evaluate and compare short term and long-term outcomes in simultaneous kidney and pancreas transplant (SPK) recipients with a history of type 2 diabetes compared to those with type 1 diabetes.

*Methods: This is a retrospective study of all kidney and pancreas transplant recipients >18 years transplanted at our center from June 2014 to July 2021. Type 1 diabetes was defined by serum evidence of autoimmunity (presence of Glutamic acid decarboxylase (GAD65), absence of insulin secretion (manifested by low or undetectable levels of plasma c-peptide) and early onset of diagnosis (age <25).

*Results: There were 102 SPK performed at our center during this time. 46 patients were type 2 diabetics and 56 type 1. Type 2 diabetics were older, mean age 48.2 +/- 9.2 years vs 38.2 +/- 8.2 years (p<0.001), had lower mean pre-transplant A1c (7.7 +/- 1.7 vs 8.3 +/- 1.6, p= 0.04), and as expected had higher c-peptide levels (5.0 +/- 2.0 vs 0.86 +/- 2.2, p<0.001). There was no difference in BMI, 25.5 +/- 3.8 in type 1 vs 26.8 +/- 3.6 in type 2, p=0.096. Most patients were black or Hispanic (83%), but comparable in both groups. There was no difference in pre-transplant insulin requirements, history of hypertension, hyperlipidemia, and dialysis vintage. There was no difference in length of hospital stay, 30 days re-admissions, incidence of delayed graft function in kidney or pancreas allografts, hypoglycemia (BS<55), and need for antiglycemics post-transplant. Mean serum creatinine levels were similar at 6 months (1.26 +/- 0.4 mg/dl vs 1.1 +/- 0.33mg/dl, p=0.1). However, type 2 diabetics had better kidney function at 1 year with mean serum creatinine levels of 1.1 +/- 0.32 mg/dl vs 1.4 +/- 0.61 mg/dl, p=0.008. There was no difference in mean HbA1c levels at 1 year (5.4 +/- 0.87 in type 1 vs 5.7 +/- 1.2 in type 2, p=0.3). At a median follow-up of 25 months (range 3-87), patient’s, kidney, and pancreas allografts’ survivals were 98%, 100%, and 93% in type 2 vs 93%, 91%, and 91% in type 1, respectively. There was no difference in clinical outcomes when type 2 diabetics were stratified by C-peptide levels >5 compared to levels <5.

*Conclusions: Outcomes post simultaneous kidney and pancreas transplant are similar in type 2 diabetes when compared to type 1 diabetes. Type 2 diabetics had statistically significant better renal function at 1 year compared to type 1 and there was a trend towards better patient and allografts’ survival, but it was not significant likely due to the small number of events.

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