{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T11:45:09Z","timestamp":1785757509737,"version":"3.56.0"},"reference-count":34,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med. Sci.","Medical Sciences"],"abstract":"<jats:p>Background: Simultaneous pancreas\u2013kidney transplantation (SPKT) restores both renal function and endogenous insulin secretion in selected patients with type 1 diabetes mellitus (T1DM) and end-stage renal disease (ESRD). Whether SPKT provides superior patient survival, kidney graft outcomes and cardiovascular benefit compared with kidney transplantation alone (KTA) remains debated, particularly when KTA is performed from a living donor. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed\/MEDLINE was searched using a predefined strategy including terms related to pancreas transplantation, kidney transplantation alone, T1DM, and ESRD\/chronic kidney disease. Eligible studies included adult T1DM\/ESRD populations comparing SPKT with KTA, including living-donor kidney transplantation (LDKT) and deceased-donor kidney transplantation (DDKT) and reporting clinically relevant outcomes. Full texts were reviewed and categorized as core comparative evidence, secondary\/supportive evidence or excluded records. A quantitative synthesis was additionally performed for studies reporting directly comparable adjusted hazard ratios for patient mortality and kidney graft failure in the SPKT versus LDKT comparison. Results: Nineteen observational studies met the inclusion criteria and were included in the qualitative synthesis. SPKT consistently provided superior metabolic control and insulin independence when pancreas graft function was maintained. Compared with deceased-donor or mixed KTA cohorts, SPKT was frequently associated with more favorable long-term patient survival and cardiovascular outcomes in selected recipients. However, comparisons with LDKT yielded less consistent results, with several registry-based analyses reporting equivalent or superior kidney graft and survival outcomes after living-donor transplantation. Quantitative synthesis of the two studies providing directly comparable adjusted hazard ratios demonstrated a higher risk of patient mortality (HR 1.30, 95% CI 1.10\u20131.54) and kidney graft failure (HR 1.43, 95% CI 1.24\u20131.66) following SPKT compared with LDKT. Formal meta-analysis of SPKT versus DDKT was not feasible because of substantial heterogeneity in outcome definitions, statistical reporting methods and follow-up duration across studies. Conclusions: In adults with T1DM and ESRD, successful SPKT provides a durable metabolic advantage and may improve long-term outcomes compared with deceased-donor KTA in selected patients. Across analyses that included all transplanted recipients from the time of surgery (intent-to-treat), early perioperative risk is higher after SPKT but may be offset over time when pancreas graft function is maintained. Evidence does not support a universal survival superiority of SPKT over living-donor kidney transplantation. Our quantitative synthesis of intent-to-treat, transplant-date analyses indicates that LDKT is associated with lower risks of patient mortality and kidney graft failure compared with SPKT when a suitable living donor is available. Treatment decisions should be individualized, considering living-donor availability, anticipated waiting time and dialysis exposure, cardiovascular and surgical risk, and the likelihood of durable pancreas graft function, with greater weight given to contemporary cohorts.<\/jats:p>","DOI":"10.3390\/medsci14040454","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T10:24:07Z","timestamp":1785752647000},"page":"454","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Simultaneous Pancreas-Kidney Transplantation Versus Kidney Transplantation Alone in Type 1 Diabetes: Does Pancreas Transplantation Improve Clinical Outcomes? A Systematic Review and Exploratory Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0730-4923","authenticated-orcid":false,"given":"Maria Irene","family":"Bellini","sequence":"first","affiliation":[{"name":"Department of Surgery, Sapienza University, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"De Intinis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sapienza University, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"D\u2019Andrea","sequence":"additional","affiliation":[{"name":"Department of Statistical Sciences, Sapienza University, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5709-2530","authenticated-orcid":false,"given":"Vito","family":"D\u2019Andrea","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sapienza University, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Vichi","sequence":"additional","affiliation":[{"name":"Department of Statistical Sciences, Sapienza University, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"A8","DOI":"10.1053\/j.ajkd.2025.02.602","article-title":"US Renal Data System 2024 Annual Data Report: Epidemiology of Kidney Disease in the United States","volume":"85","author":"Johansen","year":"2025","journal-title":"Am. J. Kidney Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.2215\/CJN.11491116","article-title":"Diabetic Kidney Disease: Challenges, Progress, and Possibilities","volume":"12","author":"Alicic","year":"2017","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"(2024). Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int., 105, S117\u2013S314.","DOI":"10.1016\/j.kint.2023.10.018"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/ajt.16738","article-title":"First world consensus conference on pancreas transplantation: Part I-Methods and results of literature search","volume":"21","author":"Boggi","year":"2021","journal-title":"Am. J. Transplant."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/ajt.16750","article-title":"First World Consensus Conference on pancreas transplantation: Part II\u2014Recommendations","volume":"21","author":"Boggi","year":"2021","journal-title":"Am. J. Transplant."},{"key":"ref_6","unstructured":"Feingold, K.R., Adler, R.A., Ahmed, S.F., Anawalt, B., Blackman, M.R., Chrousos, G., Corpas, E., de Herder, W.W., Dhatariya, K., and Dungan, K. (2026, June 15). Update on Pancreatic Transplantation in the Management of Diabetes, Endotext [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK278979\/."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014A web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_8","unstructured":"Wells, G.A., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2000). The Newcastle\u2013Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses, Ottawa Hospital Research Institute."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"105906","DOI":"10.1016\/j.ijsu.2021.105906","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"88","author":"Page","year":"2021","journal-title":"Int. J. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1016\/S0140-6736(95)92838-3","article-title":"Mortality of cadaveric kidney transplantation versus combined kidney-pancreas transplantation in diabetic patients","volume":"346","author":"Manske","year":"1995","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1016\/S0041-1345(98)00488-6","article-title":"Outcome of kidney transplantation alone versus synchronous pancreas-kidney transplantation in type 1 diabetics","volume":"30","author":"Cattral","year":"1998","journal-title":"Transplant. Proc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/j.1399-0012.1998.tb01075.x","article-title":"Assessment of function and survival as measures of renal graft outcome following kidney and kidney-pancreas transplantation in type I diabetics","volume":"12","author":"Douzdjian","year":"1998","journal-title":"Clin. Transplant."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1097\/00000658-200003000-00015","article-title":"Simultaneous pancreas-kidney transplantation and living related donor renal transplantation in patients with diabetes: Is there a difference in survival?","volume":"231","author":"Rayhill","year":"2000","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/S0041-1345(01)02727-0","article-title":"Simultaneous pancreas-kidney transplant compared with kidney transplant in type I diabetic patients with end-stage renal disease","volume":"34","author":"Navarro","year":"2002","journal-title":"Transplant. Proc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1002\/bjs.4208","article-title":"Improved patient survival in recipients of simultaneous pancreas-kidney transplant compared with kidney transplant alone in patients with type 1 diabetes mellitus and end-stage renal disease","volume":"90","author":"Mohan","year":"2003","journal-title":"Br. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1053\/ajkd.2003.50057","article-title":"Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure","volume":"41","author":"Reddy","year":"2003","journal-title":"Am. J. Kidney Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1093\/ndt\/gfl771","article-title":"Surgical complications and renal function after kidney alone or simultaneous pancreas-kidney transplantation: A matched comparative study","volume":"22","author":"Marrero","year":"2007","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"845","DOI":"10.2215\/CJN.02250508","article-title":"Living donor kidney versus simultaneous pancreas-kidney transplant in type I diabetics: An analysis of the OPTN\/UNOS database","volume":"4","author":"Young","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_19","doi-asserted-by":"crossref","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":"ref_20","doi-asserted-by":"crossref","first-page":"137","DOI":"10.9738\/INTSURG-D-13-00050.1","article-title":"The impact of method on kidney graft and patient survival in kidney-pancreas transplantations for type I diabetes mellitus","volume":"100","author":"Dinckan","year":"2015","journal-title":"Int. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1111\/tri.12957","article-title":"An analysis of the survival outcomes of simultaneous pancreas and kidney transplantation compared to live donor kidney transplantation in patients with type 1 diabetes: A UK Transplant Registry study","volume":"30","author":"Barlow","year":"2017","journal-title":"Transpl. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1111\/j.1432-2277.2005.00182.x","article-title":"Progression of macrovascular diseases is reduced in type 1 diabetic patients after more than 5 years successful combined pancreas-kidney transplantation in comparison to kidney transplantation alone","volume":"18","author":"Biesenbach","year":"2005","journal-title":"Transpl. Int."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Lange, U.G., Rademacher, S., Zirnstein, B., Sucher, R., Semmling, K., Bobbert, P., Lederer, A.A., Buchloh, D., Seidemann, L., and Seehofer, D. (2021). Cardiovascular outcomes after simultaneous pancreas kidney transplantation compared to kidney transplantation alone: A propensity score matching analysis. BMC Nephrol., 22.","DOI":"10.1186\/s12882-021-02522-8"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Catarinella, D., Williford, S., Rusconi, F., Caldara, R., and Piemonti, L. (2025). Simultaneous Pancreas-Kidney Versus Kidney Transplant Alone: Real-World Outcomes in a Propensity-Matched Global Cohort. Transpl. Int., 38.","DOI":"10.3389\/ti.2025.15709"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Budhiraja, P., Lopez, R., Arrigain, S., and Schold, J.D. (2025). Reassessing Simultaneous Pancreas-Kidney Vs. Kidney Transplant Alone: A Propensity-Weighted Analysis of Survival and Morbidity. Transpl. Int., 38.","DOI":"10.3389\/ti.2025.14934"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1034\/j.1399-0012.2000.140510.x","article-title":"Combined pancreas and kidney transplantation improves survival in patients with end-stage diabetic nephropathy","volume":"14","author":"Tollemar","year":"2000","journal-title":"Clin. Transplant."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1038\/ki.2012.430","article-title":"Pancreas-kidney transplantation is associated with reduced fracture risk compared with kidney-alone transplantation in men with type 1 diabetes","volume":"83","author":"Nikkel","year":"2013","journal-title":"Kidney Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3494","DOI":"10.1016\/S0041-1345(01)02412-5","article-title":"Simultaneous pancreas-kidney transplant compared with kidney transplant in Type I diabetic patients with end-stage renal disease","volume":"33","author":"Navarro","year":"2001","journal-title":"Transplant. Proc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1016\/S0041-1345(96)00392-2","article-title":"Superior survival after simultaneous pancreas and kidney transplantation compared with transplantation of a kidney alone in diabetic recipients followed for 8 years","volume":"29","author":"Tibell","year":"1997","journal-title":"Transplant. Proc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1007\/s001250050034","article-title":"Comparison of progression of macrovascular diseases after kidney or pancreas and kidney transplantation in diabetic patients with end-stage renal disease","volume":"43","author":"Biesenbach","year":"2000","journal-title":"Diabetologia"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1016\/j.transproceed.2004.12.239","article-title":"Comparable kidney graft survival of type 1 diabetics treated with simultaneous pancreas-kidney transplantation and nondiabetic patients treated with cadaveric renal transplantation","volume":"37","author":"Fritsche","year":"2005","journal-title":"Transplant. Proc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/j.transproceed.2004.04.064","article-title":"There are no differences in pretransplant characteristics of individuals receiving simultaneous pancreas-kidney transplant and individuals with type 1 diabetes mellitus receiving living-related kidney transplant","volume":"36","author":"Donigan","year":"2004","journal-title":"Transplant. Proc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3609","DOI":"10.1016\/j.transproceed.2013.10.019","article-title":"Pancreas graft survival in simultaneous pancreas-kidney versus pancreas-after-kidney and pancreas alone transplantations: A single institution experience","volume":"45","year":"2013","journal-title":"Transplant. Proc."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2025). 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025. Diabetes Care, 48, S27\u2013S49.","DOI":"10.2337\/dc25-S002"}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/4\/454\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T10:55:33Z","timestamp":1785754533000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/4\/454"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["medsci14040454"],"URL":"https:\/\/doi.org\/10.3390\/medsci14040454","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]}}}