Simultaneous Pancreas/Kidney transplantation at the Penn Transplant Institute
For persons with end-stage renal disease, simultaneous pancreas/kidney transplantation offers a life free of dialysis and insulin-dependence, as well as better glycemic control and longer survival than kidney transplantation alone.
The Penn Transplant Institute (PTI) offers all forms of pancreas transplantation, including simultaneous pancreas/kidney transplantation (SPK), pancreas after kidney transplant (PAK), and pancreas transplant alone (PTA).
Approximately 85 percent of pancreas transplants in the United States are SPKs, a procedure offered at the PTI to patients with end-stage kidney disease (ESKD), including individuals with insulin-dependent diabetes who have chronic kidney disease (CKD). For patients with insulin-dependent type 1 diabetes and CKD/ESKD, SPK is the best available treatment because it offers outstanding long-term patient survival and maintains excellent kidney and pancreas graft survival compared to other options. Insulin independence can also be achieved in most patients with type 2 diabetes having SPK.
A growing subset of patients receiving the procedure at the PTI have type 2 diabetes (48 percent of SPKs in 2024). PAK and PTA surgeries are also available at the PTI, whose specialists closely follow kidney function in both situations.
SPK for Candidates with Diabetes
Because kidney transplantation alone cannot address the metabolic issues of diabetes, SPK offers unique advantages to patients with CKD/ESKD, whose treatment options (outside of kidney transplantation) are limited to peritoneal dialysis and hemodialysis.
Most patients anticipating a kidney transplant will undergo dialysis as a bridge to transplant. Dialysis is associated with significant complications for all patients, but for patients with diabetes it carries additional risks, including hemodynamic instability and problematic glycemic control.
Survival rates: SPK vs. Kidney Transplantation Alone (KTA)
Kidney transplantation is an ideal approach for CKD/ESRD patients, but the average wait time for a deceased donor kidney in the United States can range from 3 to 5 years (or up to 10 years in the Mid-Atlantic region). Waiting times for a kidney transplant alone (KTA) from a living donor can be considerably shorter, but securing a living donor can be challenging (only a third of kidney transplants in the US involve living donors).
Like living donor KT, waiting time for SPK can be much shorter (generally < 1 year) than a deceased donor KTA. As a result, SPK can preempt or minimize dialysis exposure for patients with diabetes and CKD/ESKD.
Patients with diabetes who do not pursue SPK, and instead undergo KTA, remain on medical therapy for diabetes, which, despite its recent improvements, lacks the capacity of tight physiological blood sugar control that a whole pancreas can provide. In addition, KTA patients require immunosuppressant therapy, increasing the risk for pathological swings in blood sugar and, as a result, the risk for kidney transplant damage from diabetes and its effects.
SPK has a substantial survival benefit versus deceased donor KTA. According to the OPTN/SRTR 2023 Annual Data Report for Kidney, approximately 82 percent of deceased donor KTA recipients are alive five years post-transplant. Among the variables in post-KTA survival, the role of diabetes was evident among deceased donor recipients, among whom 76.8 percent were alive at five years. KTA living donor recipients with diabetes fared better, with 85.8 percent survival at five years. By comparison, the national patient survival rate for SPK at five years post-transplant is 90.7 percent.
SPK vs PAK
SPK is more widely performed than PAK because PAK is generally dependent upon access to a living donor. The attendant advantages of SPK vs PAK include the relative benefits of a single procedure versus multiple surgeries, and an immunologic benefit for the pancreas in that the kidney from the same donor can signal early rejection of the pancreas, conferring increased long-term pancreas graft survival compared to PAK.
Outcomes data
According to the most recent OPTN/SRTR Annual Data Report :
SPK data
- SPK is increasing as a transplant option. The number of new listings in SPK was the highest in a decade, and higher than both PAK and PTA.
- SPK kidney 1-year graft survival averaged 96.2 percent in 2022.
- SPK was a dominant element on the waiting list, with 79.2 percent of listings vs. pancreas transplant only (12.6 percent) and pancreas-after-kidney (8.3 percent).
Diabetes as a factor in pancreas transplant
- The proportion of older candidates (age 55 years or older) increased over the previous decade, consistent with an increasing number of candidates with type 2 diabetes on the waiting list.
- Pancreas recipients with type 2 diabetes increased by 3 percent between 2022 and 2023; individuals with diabetes on the waiting list for a pancreas increased by ~2 percent in this timeframe.
SPK at the Penn Transplant Institute
- In the past two years, >48 percent of patients on the SPK waitlist at the PTI have received a transplant within one year of entering the waiting list.
- Between July 2022 and July 2025, 62 SPK transplants took place.
- More than a third (37.1 percent) of deceased donor SPK transplant recipients at the PTI were African-American; all SPK recipients from fiscal year (FY) 2023 to FY 2025 were between the ages of 32 and 59; of these, 21 percent were between ages 35-49.
- According to the July 2025 SRTR national kidney-pancreas report, among deceased donor transplant recipients, the expected probability of surviving with a functioning graft post-SPK (when adjusted for patient and donor characteristics) is 98.93 percent at one month, 96.09 percent at one year, and 88.86 percent at 3 years. These outcomes at the PTI, however, are 100 percent, 100 percent, and 87.84 percent, respectively.
- Per the July 2025 SRTR report, for kidney-pancreas deceased donor transplant recipients, the expected probability of patient survival following SPK (when adjusted for patient and donor characteristics) is 98.34 percent at 90 days, 96.83 percent at one year, and 94.19 percent at three years. However, PTI outcomes are 100 percent, 100 percent, and 93.75 percent respectively.
Case Study One: SPK with type 1 diabetes
Mrs. M, a 46-year-old woman, was referred to the PTI with a medical history that included type 1 diabetes complicated by a panoply of comorbidities caused by the disease, including end-stage kidney disease, retinopathy, neuropathy, autonomic dysfunction, peripheral vascular disease, gastroparesis, and loss of hypoglycemic awareness.
At her arrival at the PTI, Mrs M had been on hemodialysis for 2.5 years and on the waiting list for a simultaneous pancreas/kidney transplant for approximately the same amount of time. Despite her impediments, her functional status was good (90 percent), and she was able to walk three times per week. While waiting for her SPK, she continued her dialysis and was encouraged to maintain weight control, diet, and exercise to avoid further risks of hypertension and hyperlipidemia.
A year later, she received a pancreas and kidney from a deceased 22-year-old woman. At the time of SPK, her transplant risk stratification placed her at moderately high risk based on her comorbidities. Her physical function was acceptable. At 46.81, her calculated panel reactive antibody (cPRA) score suggested that she would be compatible with more than half of potential donors.
At transplant, Mrs. M’s estimated post-transplant survival (EPTS) score (used in conjunction with the Kidney Donor Profile Index (KDPI) score to calculate the likely length of kidney function) was 48, placing her roughly in the middle of post-transplant expectations for graft survival. At 14 percent, her donor’s KDPI indicated good kidney quality and the potential for longer function.
Following the transplant, there was no delay in kidney function. Subsequent testing disclosed a cytomegalovirus (CMV) donor/recipient mismatch and a positive finding for Epstein-Barr virus (EBV) in both donor and recipient. Prophylactic CMV treatment was provided for 6 months and EBV surveillance was maintained per our routine protocol.
At a follow-up visit a year after her SPK, Mrs. M’s renal function was stable, as was her pancreatic function, as evidenced by acceptable amylase and lipase blood levels. Her immunosuppressant medications at this time included tacrolimus and myfortic.
Case 2: SPK with type 2 diabetes
Mr. G, a 56-year-old man, was referred to the Penn Transplant Institute for consultation following a series of health concerns leading to a pronounced decline in renal function. Among these issues were a three-year history of type 2 diabetes with presumed diabetic kidney disease, proteinuric ESRD, hypertension, and latent forms of tuberculosis, schistosomiasis, and toxocara, as well as evidence of a prior toxoplasma gondii infection.
After consideration of his medical history, it was recommended that Mr. G pursue a simultaneous pancreas/kidney transplant, given his history of kidney disease and that individual infections with either schistosomiasis, toxocara, or toxoplasma gondii may lead to irreversible pancreatic damage.
Mr. G consented to an SPK, and his surgery took place two months after his initial consultation. His donor was a healthy, normal weight 32-year-old man who’d died following severe head trauma. On evaluation, the donor kidney was a good match for Mr. G (KDPI 41 percent, CPRA6) and of normal size and vascular configuration. Testing prior to transplant suggested that Mr. G was positive for the cytomegalovirus (CMV), but the donor kidney was not, and that both donor and recipient were positive for Epstein-Barr virus (EBV). In addition, Mr. G was found to have hyperaldosteronism.
Mr. G’s SPK surgery was uncomplicated, and he weathered the procedure well. He is now 3 months post-SPK. He continues to do well from a kidney transplant standpoint with a baseline creatinine of 0.9-1.2 mg/dL (since starting Aldactone). His most recent test for BK virus (a common virus that may be triggered by immunosuppression) is negative. His pancreas graft function is stable with normal amylase/lipase. He is euglycemic off insulin, and his most recent hba1c (an evaluation for post-transplant diabetes risk) is normal at 5.3 percent; his c-peptide is 8.9, suggesting good initial pancreatic graft function.
Mr. G is on spironolactone 50 twice daily. His blood pressure is acceptable. His current medications include tacrolimus and prednisone for immunosuppression, prophylactic Bactrim SS daily (through 6 months) and the aldosterone receptor antagonist spironolactone.
About the Penn Transplant Institute Pancreas and Islet Transplant Program
The Penn Transplant Institute pancreas transplant program was the first program in the region to offer pancreas transplant as treatment for type 1 diabetes and is one of the leading transplant centers in the world researching islet cell transplantation. As a member of the Clinical Islet Transplantation Consortium funded by the National Institutes of Health, we participate in clinical trials for islet transplantation in addition to clinical trials studying aspects of pancreas transplantation.
Clinical consult and patient referral
To refer a patient to the Penn Transplant Instutute, please call 800-789-7366, or submit a referral through our secure online referral form.
SPK transplant surgeons