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This study compared metabolic and macrovascular disease outcomes between SPKTx and KTx in recipients with type 1 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a systematic search of the Embase, MEDLINE and Scopus databases (last searched 23 February 2025). We included retrospective and case\u2013control studies, owing to a lack of randomised controlled trials in English, with adult patients. We excluded studies reporting on a return to dialysis post transplant, islet\u2013kidney transplantation or separate pancreas\u2013kidney transplants. Bias and study quality were assessed via the Newcastle\u2013Ottawa scale for cohort studies. Demographic and outcome data were synthesised as both categorical and continuous data, with pooled means and summary statistics computed where applicable. Meta-analysis was performed on post-transplant outcomes in studies evaluating total cholesterol (TC), triglyceride (TG) level, HDL, LDL, blood pressure, HbA\n                      <jats:sub>1c<\/jats:sub>\n                      and renal function. Macrovascular outcomes included the frequency of new or adverse events associated with coronary artery disease (CAD), cerebrovascular disease (CeVD) and peripheral vascular disease (PVD).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 15 studies (\n                      <jats:italic>n<\/jats:italic>\n                      =564 SPKTx, 419 KTx) were included. Meta-analysis demonstrated lower post-transplant TC (mean difference \u22120.41 mmol\/l [95% CI \u22120.60, \u22120.22],\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.01,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =37%), TG level (mean difference \u22120.76 mmol\/l [95% CI \u22121.02, \u22120.49],\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.01,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =86%), LDL (mean difference \u22120.28 mmol\/l [95% CI \u22120.42, \u22120.14],\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.01,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =15%), HbA\n                      <jats:sub>1c<\/jats:sub>\n                      (mean difference \u221228.79 mmol\/mol [95% CI \u221235.75, \u221221.82],\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.01,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =98%; mean difference \u22122.61% [95% CI \u22123.05, \u22122.16],\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.01) and creatinine levels (mean difference \u221221.54 \u03bcmol\/l [95% CI \u221239.23, \u22123.85],\n                      <jats:italic>p<\/jats:italic>\n                      =0.02,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      =90%) following SPKTx compared with KTx. Mean antihypertensive agent use per participant decreased post SPKTx (1.0 vs 2.5 pre transplant;\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.01), but was not significantly different from post-KTx groups. HbA\n                      <jats:sub>1c<\/jats:sub>\n                      increased following KTx (69 mmol\/mol [8.5%]) compared with pre KTx (53 mmol\/mol [7.0%],\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.01). Progression of CAD, CeVD and PVD occurred across both groups post transplant. PVD showed more than a twofold increase in amputations and revascularisations post transplant. No difference was observed in the post-transplant frequency of CAD, CeVD or PVD between SPKTx and KTx. Evidence from this study was limited by a lack of subgroup data for analysis, a lack of randomised studies and a paucity of reported lifestyle factors influencing outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>SPKTx demonstrates a superior metabolic profile post transplant to that in KTx in recipients with type 1 diabetes. However, this does not translate into differences in the risk of CAD or PVD post transplant, with PVD accounting for the greatest burden of macrovascular disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>This protocol has been registered a priori on PROSPERO (CRD42024622408).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06843-x","type":"journal-article","created":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T14:54:57Z","timestamp":1788015297000},"page":"3196-3209","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metabolic and macrovascular outcomes following simultaneous pancreas\u2013kidney transplantation and kidney transplantation alone in recipients with type 1 diabetes mellitus: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"69","author":[{"given":"Harsham","family":"Choksi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowan","family":"Klein Nulend","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tess","family":"Cooper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Au","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Pleass","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha M.","family":"Rogers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"issue":"1","key":"6843_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12933-019-0953-7","volume":"18","author":"YB Lee","year":"2019","unstructured":"Lee YB, Han K, Kim B et al (2019) Risk of early mortality and cardiovascular disease in type 1 diabetes: a comparison with type 2 diabetes, a nationwide study. 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The authors acknowledge that there is an overlap with material previously presented in Dr H. Choksi\u2019s PhD thesis (University of Sydney,\n                      \n                      ), on which this work is based.","order":1,"name":"Ethics","label":"Acknowledgements","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"The majority of data supporting the findings of this study are available within the paper and its ESM. The raw data, prior to statistical analysis, are not openly available; however, they can be made accessible from the authors on request for clearly outlined purposes from reputed sources. Data can be made available to researchers requiring further clarification of methodology where appropriate or where quoting\/referencing the article where data have not been presented already.","order":2,"name":"Ethics","label":"Data availability","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Open Access funding enabled and organized by CAUL and its Member Institutions.","order":3,"name":"Ethics","label":"Funding","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","label":"Authors\u2019 relationships and activities","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"HC, TC, EA, HP and NMR were involved in project conception and manuscript writing. HC and TC developed and wrote the protocol. HC and RKN conducted the systematic review process including searching medical databases and extracting selected studies. HC, TC, EA, HP and NMR performed data analysis. HC and NMR wrote the manuscript. All authors had full access to the data, critically reviewed the manuscript and made the decision to submit for publication. HC and NMR accept full responsibility for this work, including the conduct of the study and providing access to the data, and made the decision to publish this work.","order":5,"name":"Ethics","label":"Contribution statement","group":{"name":"EthicsHeading","label":"Ethics"}}]}}