Is Age Just a Number? Outcomes of Simultaneous Pancreas-Kidney Transplantation in Patients ≥60 Years-A Contemporary SRTR Analysis

Abstract

Background: Simultaneous pancreas-kidney (SPK) transplantation offers insulin independence and freedom from dialysis for appropriately selected candidates with diabetes and end-stage renal disease. As SPK utilization increasingly extends to older recipients, including those aged ≥60 years, contemporary outcome data for these older recipients remains limited. This study evaluated age-specific outcomes to inform the selection and counseling of older SPK candidates.

Methods: Adult SPK recipients in the United States from 2010 to 2025 were identified in the Scientific Registry of Transplant Recipients and categorized into three age groups: 18-39, 40-59, and ≥60 years. Primary endpoints were patient survival and death-censored pancreas and kidney graft survival; secondary endpoints included 90-day surgical and medical complications.

Results: Among 11 995 SPK recipients, 4938 (41%) were aged 18-39 years, 6718 (56%) were 40-59 years, and 339 (3%) were ≥60 years, with utilization in the ≥60 group increasing over time. Older recipients were more likely to have Type 2 diabetes, greater comorbidity burden, and to undergo preemptive transplantation. Death-censored pancreas graft survival at 5 years improved across age strata (82.5% for 18-39, 87.5% for 40-59, and 92.2% for ≥60 years; p < 0.0001), as did death-censored kidney graft survival (86.1%, 92.8%, and 94.2%, respectively; p < 0.0001). In contrast, 5-year overall survival declined with age, from 92.4% (18-39) to 90.3% (40-59) and 82.6% (≥60; p < 0.0001), while 5-year composite kidney graft survival or death was highest in the 40-59 group (81.4%, 85.0%, and 78.6% for 18-39, 40-59, and ≥60 years; p < 0.0001). Most perioperative complications were similar across age groups, although anastomotic leak was more frequent in recipients ≥60 years.

Conclusions: Carefully selected SPK recipients aged ≥60 years achieve excellent pancreas and kidney graft survival, often exceeding outcomes observed in younger adults, despite higher overall mortality. These findings support reconsideration of strict age-based exclusion criteria and highlight the importance of nuanced risk-benefit discussions for older SPK candidates.