Early clinical outcomes in the first 37 recipients following simultaneous pancreas–kidney transplantation in Denmark after program reinitiation

Background: Simultaneous pancreas-kidney transplantation (SPK) remains the most effective treatment for patients with type 1 diabetes and end-stage renal disease, yet outcomes vary across centers and regions. After re-establishing the Danish national SPK program in 2015, we evaluated early metabolic, renal and graft outcomes in the first consecutive recipients to benchmark performance against established international centers.
Methods: This single-center retrospective cohort included 37 consecutive SPK recipients transplanted between 2015-2021. Serum creatinine, eGFR, plasma glucose, HbA1c and C-peptide we recorded preoperatively and at postoperative days 7,14, 30, 90 and 365. One-year patient, kidney and pancreas graft survival were assessed. All patients underwent standardized daily graft ultrasonography during first postoperative week. Length of stay (LOS) was recorded.

Results: Metabolic and renal parameters improved over the first postoperative year. Mean creatinine decreased from 654.8 µmol/L to 129.1 µmol/L, corresponding to an increase in mean eGFR from 8.19 to 56.15 mL/min/1.73 m². C‑peptide rose from 64.3 to 1,097.9 pmol/L, while plasma glucose normalized from 13.6 to 5.45 mmol/L. HbA1c declined from 63.2 to 35.3 mmol/mol. One‑year patient survival was 94.6%; both deaths occurred within the first 4 months. Death‑censored kidney graft survival was 100%, and 97.1% of surviving patients remained insulin‑independent at 12 months. Median LOS was 19 days. Routine evening ultrasonography did not influence management, whereas morning scans supported specialized SPK ward rounds.

Conclusion: The re‑established Danish SPK program demonstrates excellent early outcomes, with rapid metabolic normalization and high one‑year patient and graft survival. Results are comparable to established European centers. These findings prompted removal of routine evening ultrasonography, reflecting a measurable improvement in postoperative workflow without loss of diagnostic safety. Long‑term follow‑up will determine graft durability and late outcomes.