Background: Pancreas and/or kidney transplantation have provided tremendous progress for diabetic patients. The purpose of this study was to assess the long-term patient and graft survival as well as the survival benefit as reported (1/1/2000 – 12/31/2022) for diabetic patients.

Methods: In this analysis, we reviewed  40,731 adult type 1 diabetic patients listed for primary pancreas and/or kidney transplant (16,035 Kidney Transplant Alone [KTA], 3,286 Pancreas after Kidney Transplant [PAK], 2,188 Pancreas Transplant Alone [PTA], 19,222 Simultaneous Pancreas and Kidney Transplant [SPK]). Of these, 25,043 patients underwent a deceased donor transplant, and 14,314 patients did not undergo a transplant and were still on the waiting list. Since most living donor transplants were in the KTA group, those transplants were separately analyzed.
We adjusted our analyses for multiple listings, incomplete diabetes classification and missing data. Primary outcome was patient survival while on the waiting list or after a transplant. 

Results: Waitlist mortality rates for patients with Type 1 diabetes mellitus are shown in Figure 1. The main factor influencing the waitlist mortality was the failed kidney function. The 5- year mortality was 52% for KTA and 48% for SPK; in contrast 18% for PAK, and 15% for PTA.
Over the analyzed time period not only the patient but also the graft survival improved for transplants in those diabetic patients. Half-lives for SPK are now clearly over 12 Years, and over 7 years for solitary transplants. When the recipients reached the first year post-transplant with a functioning graft the half-live of a solitary  pancreas also reached 10 years.
We found that a total of 174,856 life-years were saved to date during the 22 years of pancreas and/or kidney transplants in type 1 diabetics . Saved life-years for DD KTA recipients were 30,581 years; for SPK recipients, 113,942 years; for PAK 20,668 years, and for PTA recipients, 9,670 years. This resulted in 7.8 life–years that were saved for every type 1 diabetic recipient of a pancreas and/or kidney transplant. The average observed number of life-years saved for DD KTA recipients was 6.8years; for SPK recipients, 8.9 years; for PAK 5.4 years and PTA recipients, 3.4 Years. The difference was highly significant (p < 0.0001).

Conclusions: Our analysis demonstrates the following: (1) Waiting list mortality was highest for patients with end-stage-renal disease (KTA, SPK).  Patient survival was highest after SPK, PTA; the lowest patient survival rate was noted in DD KTA; (3) At 5-years, patient mortality rates from time of listing for  transplanted  vs. waiting patients was 87% vs 30% for DD KTA and 92% and 22% for SPK recipients (4) More average life-years were saved with SPK than with DD KTA; (5) To date, primary DD pancreas and/or kidney transplants in type 1 diabetics have saved almost 300,000 life-years.