{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:23:33Z","timestamp":1792790613481,"version":"4.5.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Transpl. Int."],"abstract":"<jats:p>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\u20132023) 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 &amp;lt; 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\u20134.49) and hospital readmissions (owOR: 2.05, 95% CI: 1.62\u20132.60). However, among recipients with type 1 diabetes and BMI &amp;lt;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.<\/jats:p>","DOI":"10.3389\/ti.2025.14934","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T14:29:46Z","timestamp":1767104986000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Reassessing Simultaneous Pancreas-Kidney Vs. Kidney Transplant Alone: A Propensity-Weighted Analysis of Survival and Morbidity"],"prefix":"10.3389","volume":"38","author":[{"given":"Pooja","family":"Budhiraja","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocio","family":"Lopez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana","family":"Arrigain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse D.","family":"Schold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1097\/00007890-200101150-00014","article-title":"The Impact of Simultaneous Pancreas-Kidney Transplantation on Long-Term Patient Survival","volume":"71","author":"Ojo","year":"2001","journal-title":"Transplantation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"549","DOI":"10.2215\/CJN.03720609","article-title":"Transplantation of the Type 1 Diabetic Patient: The Long-Term Benefit of a Functioning Pancreas Allograft","volume":"5","author":"Morath","year":"2010","journal-title":"Clin J Am Soc Nephrol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1056\/NEJM199807093390202","article-title":"Reversal of Lesions of Diabetic Nephropathy After Pancreas Transplantation","volume":"339","author":"Fioretto","year":"1998","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"S121","DOI":"10.1016\/j.ajt.2023.02.005","article-title":"OPTN\/SRTR 2021 Annual Data Report: Pancreas","volume":"23","author":"Kandaswamy","year":"2023","journal-title":"Am J Transpl"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1111\/tri.13892","article-title":"Metabolic Outcomes and Renal Function After Simultaneous Kidney\/Pancreas Transplantation Compared With Kidney Transplantation Alone for Type 2 Diabetes Mellitus Patients","volume":"34","author":"Fu","year":"2021","journal-title":"Transpl Int"},{"key":"B6","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1186\/s12882-021-02522-8","article-title":"Cardiovascular Outcomes After Simultaneous Pancreas Kidney Transplantation Compared to Kidney Transplantation Alone: A Propensity Score Matching Analysis","volume":"22","author":"Lange","year":"2021","journal-title":"BMC Nephrol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"665","DOI":"10.2337\/dc18-2111","article-title":"Major Adverse Cardiovascular Events Following Simultaneous Pancreas and Kidney Transplantation in the United Kingdom","volume":"42","author":"Yiannoullou","year":"2019","journal-title":"Diabetes Care"},{"key":"B8","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1007\/s00423-021-02249-y","article-title":"Simultaneous Pancreas and Kidney Transplantation for End-Stage Kidney Disease Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis","volume":"407","author":"Cao","year":"2022","journal-title":"Langenbecks Arch Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s12902-020-0506-9","article-title":"Short and Long-Term Metabolic Outcomes in Patients With Type 1 and Type 2 Diabetes Receiving a Simultaneous Pancreas Kidney Allograft","volume":"20","author":"Hau","year":"2020","journal-title":"BMC Endocr Disord"},{"key":"B10","doi-asserted-by":"publisher","first-page":"S138","DOI":"10.1016\/j.ajt.2025.01.021","article-title":"OPTN\/SRTR 2023 Annual Data Report: Pancreas","volume":"25","author":"Kandaswamy","year":"2025","journal-title":"Am J Transpl"},{"key":"B11","doi-asserted-by":"publisher","first-page":"10618","DOI":"10.3389\/ti.2022.10618","article-title":"Survival After Simultaneous Pancreas-Kidney Transplantation in Type 1 Diabetes: The Critical Role of Early Pancreas Allograft Function","volume":"35","author":"Ji","year":"2022","journal-title":"Transpl Int"},{"key":"B12","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1111\/ajt.15615","article-title":"Three-Month Pancreas Graft Function Significantly Influences Survival Following Simultaneous pancreas-kidney Transplantation in Type 2 Diabetes Patients","volume":"20","author":"Alhamad","year":"2020","journal-title":"Am J Transpl"},{"key":"B13","unstructured":"Technical Methods for the Program-Specific Reports\n          \n          \n          2025"},{"key":"B14","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1111\/j.1600-6143.2009.02996.x","article-title":"Systematic Evaluation of Pancreas Allograft Quality, Outcomes and Geographic Variation in Utilization","volume":"10","author":"Axelrod","year":"2010","journal-title":"Am J Transpl"},{"key":"B15","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1097\/TP.0b013e3181ac620b","article-title":"A Comprehensive Risk Quantification Score for Deceased Donor Kidneys: The Kidney Donor Risk Index","volume":"88","author":"Rao","year":"2009","journal-title":"Transplantation"},{"key":"B16","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1093\/aje\/kwy201","article-title":"Addressing Extreme Propensity Scores Via the Overlap Weights","volume":"188","author":"Li","year":"2019","journal-title":"Am J Epidemiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"3721","DOI":"10.1177\/0962280220940334","article-title":"Propensity Score Weighting Under Limited Overlap and Model Misspecification","volume":"29","author":"Zhou","year":"2020","journal-title":"Stat Methods Med Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1900","DOI":"10.1097\/TP.0000000000000663","article-title":"A Reassessment of the Survival Advantage of Simultaneous Kidney-Pancreas Versus Kidney-Alone Transplantation","volume":"99","author":"Sung","year":"2015","journal-title":"Transplantation"},{"key":"B19","doi-asserted-by":"publisher","first-page":"321","DOI":"10.2337\/dc19-1580","article-title":"Superior Long-Term Survival for Simultaneous Pancreas-Kidney Transplantation as Renal Replacement Therapy: 30-Year Follow-Up of a Nationwide Cohort","volume":"43","author":"Esmeijer","year":"2020","journal-title":"Diabetes Care"},{"key":"B20","doi-asserted-by":"publisher","first-page":"729","DOI":"10.1056\/NEJMra2014530","article-title":"Long-Term Survival After Kidney Transplantation","volume":"385","author":"Hariharan","year":"2021","journal-title":"N Engl J Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1111\/ajt.16979","article-title":"OPTN\/SRTR 2020 Annual Data Report: Pancreas","volume":"22","author":"Kandaswamy","year":"2022","journal-title":"Am J Transpl"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1111\/ajt.12167","article-title":"Acute Pancreas Allograft Rejection Is Associated with Increased Risk of Graft Failure in Pancreas Transplantation","volume":"13","author":"Dong","year":"2013","journal-title":"Am J Transpl"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1188","DOI":"10.1097\/01.tp.0000137198.09182.a2","article-title":"Technical Failures After Pancreas Transplants: Why Grafts Fail and the Risk factors--a Multivariate Analysis","volume":"78","author":"Humar","year":"2004","journal-title":"Transplantation"}],"container-title":["Transplant International"],"original-title":[],"link":[{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2025.14934\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T14:29:47Z","timestamp":1767104987000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2025.14934\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,30]]},"references-count":23,"alternative-id":["10.3389\/ti.2025.14934"],"URL":"https:\/\/doi.org\/10.3389\/ti.2025.14934","relation":{},"ISSN":["1432-2277"],"issn-type":[{"value":"1432-2277","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,30]]},"article-number":"14934"}}