Independent Risk Architecture of 7-Day Graft Loss After Adult Simultaneous Pancreas-Kidney Transplantation: A National Registry Analysis.

OBJECTIVES: Seven -day graft loss after simultaneous pancreas -kidney transplant remains incompletely characterized. This retrospective registry analysis examined the incidence, etiologies, and predictors of 7 -day graft loss after simultaneous pancreas -kidney transplant. MATERIALS AND METHODS: We analyzed all adult deceased donor simultaneous pancreas -kidney transplant recipients from the Organ Procurement and Transplantation Network (2015 -2024 ). We compared recipients who had 7 -day graft loss (ie, pancreas graft failure, kidney graft failure, or death within 7 postoperative days [non -death -censored ] ) with recipients who had achieved at least 1 -year dual -graft survival. We used multivariable logistic regression to identify predictors. RESULTS: Among 6362 recipients, 304 (4.8 % ) experienced 7 -day graft loss. Pancreas graft failure predominated (94.4 % vs 12.5 %; P < .001 ), followed by kidney graft failure (32.2 % vs 12.4 %; P < .001 ). Thrombosis was the leading etiology, followed by primary nonfunction. Twenty-four recipients lost both allografts simultaneously; all 16 deaths within the 7 -day analysis period occurred within this subset. In a model restricted to recipients with pretransplant C -peptide values, body mass index (calculated as weight in kilograms divided by height in meters squared ) ≥30 (odds ratio 1.747; P = .001 ), donor hypertension (odds ratio 1.767; P = .035 ), male sex (odds ratio 0.699; P = .005 ), and each 0.1 ng /mL C -peptide decrement (odds ratio 1.006; P = .029 ) independently predicted 7 -day graft loss. Dialysis vintage predicted simultaneous dual -graft failure and early death. CONCLUSIONS: Seven -day graft loss complicated nearly 1 in 20 simultaneous pancreas -kidney transplant procedures. These predictors constitute actionable targets for preoperative risk stratification and donor -recipient matching.