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This retrospective study used data from the Organ Procurement and Transplantation Network (OPTN) to assess whether donor body mass index (BMI) affects outcomes after primary simultaneous pancreas\u2010kidney transplantation. The analysis included 9519 adult recipients transplanted from 2010 through 2022. Donors were categorized by BMI as underweight, normal weight, overweight, or obese. Kaplan\u2013Meier analysis, Cox proportional hazards models, and restricted cubic spline modeling were used to compare outcomes across groups. Donor BMI was not associated with significant differences in one\u2010 or three\u2010year patient survival or death\u2010censored pancreas and kidney graft survival, and multivariable Cox regression analysis found donor BMI to not be an independent predictor of graft loss. Instead, factors associated with one\u2010year graft failure included donor age over 45 years, cerebrovascular accident as the cause of death, and cold ischemia time longer than 12\u00a0h. These findings indicate that carefully selected pancreata from donors with higher BMI can achieve outcomes comparable to those from normal\u2010weight donors, supporting reconsideration of BMI\u2010based exclusion criteria to expand the donor pool and increase pancreas transplantation rates.<\/jats:p>","DOI":"10.1111\/ctr.70611","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T15:00:04Z","timestamp":1784214004000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Expanding the Pancreas Donor Pool: Reassessing the Impact of Donor Body Mass Index on Transplant Outcomes"],"prefix":"10.1111","volume":"40","author":[{"given":"Alexander","family":"Jurkovich","sequence":"first","affiliation":[{"name":"University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Surgery Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma S.","family":"Crichton","sequence":"additional","affiliation":[{"name":"Department of Surgery Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tia","family":"Ketsan","sequence":"additional","affiliation":[{"name":"University of California Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evronia","family":"Baselious","sequence":"additional","affiliation":[{"name":"University of California Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujie","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Voidonikolas","sequence":"additional","affiliation":[{"name":"Department of Surgery Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kambiz","family":"Kosari","sequence":"additional","affiliation":[{"name":"Department of Surgery Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas N.","family":"Nissen","sequence":"additional","affiliation":[{"name":"Department of Surgery Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Todo","sequence":"additional","affiliation":[{"name":"Department of Surgery Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin A.","family":"Steggerda","sequence":"additional","affiliation":[{"name":"Department of Surgery Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven A.","family":"Wisel","sequence":"additional","affiliation":[{"name":"Department of Surgery Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene K.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Surgery Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd V.","family":"Brennan","sequence":"additional","affiliation":[{"name":"Department of Surgery Cedars\u2010Sinai Medical Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109119"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc24\u2010S002"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc13\u20102112"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.29.04.06.dc06\u20109908"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1321"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16750"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2025.01.021"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2014.12.020"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000004113"},{"key":"e_1_2_10_11_1","unstructured":"Health Resources & Services Administration (HRSA).Organ Procurement and Transplantation Network (OPTN). 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