AUTHOR=Budhiraja Pooja , Lopez Rocio , Arrigain Susana , Schold Jesse D. 
  
TITLE=Reassessing Simultaneous Pancreas-Kidney Vs. Kidney Transplant Alone: A Propensity-Weighted Analysis of Survival and Morbidity
  
JOURNAL=Transplant International
  
VOLUME=Volume 38 - 2025
  
YEAR=2025
  
URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2025.14934
  
DOI=10.3389/ti.2025.14934
  
ISSN=1432-2277
  
ABSTRACT=This study compares outcomes between Simultaneous Pancreas-Kidney Transplantation (SPKT) and Deceased Donor Kidney Transplantation (DDKT) in recipients with diabetes, assessing survival benefits against surgical and immunological risks. We analyzed Scientific Registry of Transplant Recipients data (2014–2023) to assess patient and kidney graft survival. Overlap propensity score weighting was applied to adjust for group differences. Kaplan-Meier and Cox proportional hazards models were used to estimate survival outcomes in unadjusted, covariate-adjusted, and weighted analyses. Among 22,545 recipients with diabetes (25% SPKT), those receiving SPKT were younger (41 vs. 52 years), predominantly non-Hispanic white, had type 1 diabetes, lower BMI, shorter dialysis duration, and higher preemptive transplant rates (all p < 0.001). Overlap-weighted (ow) analyses showed no significant differences in 5- and 10-year patient (SPKT: 86%, 71%; DDKT: 87%, 74%) and kidney graft survival (SPKT: 80%, 66%; DDKT: 83%, 62%). SPKT recipients with graft survival at 1 year experienced higher 1-year treated acute rejection (owOR: 2.80, 95% CI: 1.75–4.49) and hospital readmissions (owOR: 2.05, 95% CI: 1.62–2.60). However, among recipients with type 1 diabetes and BMI <30, SPKT was associated with lower mortality compared to DDKT. After adjustment for selection bias, SPKT did not improve long-term survival compared to DDKT and was associated with greater early morbidity.