Determinants of Cardiovascular Events After Simultaneous Pancreas Kidney Transplantation: A Retrospective Cohort Study.

Background Simultaneous pancreas-kidney transplantation (SPK) provides important metabolic and renal benefits, but cardiovascular complications remain a source of post-transplant morbidity and mortality. Factors associated with major adverse cardiovascular events (MACE) in contemporary SPK populations remain incompletely characterized. Methods We performed a single-center retrospective cohort analysis of 80 adult SPK recipients transplanted between 2018 and 2025. The primary endpoint was post-transplant MACE, defined as a composite of nonfatal myocardial infarction, nonfatal stroke, cardiovascular death, heart failure hospitalization, or clinically significant arrhythmia. MACE was evaluated as a binary outcome. The multivariable logistic regression model included one-month estimated glomerular filtration rate (eGFR) and kidney cold ischemic time. Results MACE occurred in 14 recipients (17.5%). Compared with recipients without MACE, those with MACE had more frequent post-transplant insulin use (P=0.013), longer kidney cold ischemic time (P=0.015), and higher donor body mass index (P=0.001). The triglyceride-glucose index was not significantly associated with MACE. In multivariable analysis, higher one-month eGFR was associated with lower odds of MACE (adjusted odds ratio, 0.61 per 10 mL/min/1.73 m² increase; 95% confidence interval (CI), 0.38-0.97; P=0.040). Kidney cold ischemic time showed a borderline association with MACE (adjusted odds ratio per hour, 1.28; 95% CI, 1.00-1.67; P=0.057). Model discrimination was modest, with an area under the curve of 0.68. Conclusions Among SPK transplant recipients, lower early kidney allograft function was associated with higher observed odds of post-transplant cardiovascular events. The triglyceride-glucose (TyG) index was not independently associated with MACE. Because few events occurred, these findings should be interpreted as exploratory and validated in larger studies.