*Purpose: The purpose of this study is to compare clinical outcomes of simultaneous pancreas-kidney transplantation (SPK) and simultaneous deceased donor pancreas and living donor kidney transplantation (SPLK) in diabetic patients with end stage renal disease.

*Methods: Data from patients who had SPK or SPLK from December, 2005 through June, 2020 at Asan medical center were retrospectively analyzed. Of 196 consecutive patients, 151 and 45 underwent SPK and SPLK, respectively. Presence of de novo DSA after transplantation, pancreas graft failure, kidney graft failure, biopsy-proven acute rejection of pancreas, biopsy-proven acute rejection of kidney were compared between the two groups.

*Results: There was no significant difference in baseline characteristics between the two groups except that , cold ischemic time of kidney graft and duration of diabetes in the SPLK group were significantly shorter compared with the SPK group (331±132min vs 85±67min P<0.001, 21.07±6.14years vs 17.86±7.99years p=0.004) and donors of SPLK was younger than those of SPK (24.91±1.22years vs 32.08 ±12.13years, p<0.001). During ten-years follow-up, death-censored pancreas graft survival rate in the SPLK group was significantly lower compared with the SPK group (P=0.048). In addition, the incidence of biopsy-proven acute rejection of the pancreas graft in the SPLK group was significantly higher compared with the SPK group (P=0.003). There was no difference in the presence of de novo DSA and the incidences of kidney graft failure, kidney biopsy proven acute rejection and mortality between SPK and SPLK recipients.

*Conclusions: It seems that there is a higher risk of death-censored graft failure and biopsy-proven acute rejection of pancreas in recipients having SPLK compared with SPK.

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