Simultaneous islet-kidney transplantation as an alternative for patients ineligible for pancreas transplant: Initial experience at a North American transplant center.

Simultaneous pancreas-kidney (SPK) transplantation is the gold standard for patients with diabetes mellitus and end-stage renal disease, but many are ineligible due to surgical risk. Simultaneous islet-kidney (SIK) transplantation offers a less invasive alternative by combining kidney transplantation with islet infusion. We report our initial North American experience with SIK. Between July 2022 and April 2025, 13 patients with type 1 diabetes mellitus and end-stage renal disease underwent SIK after being declined for SPK, primarily due to peripheral vascular disease. Follow-up ranged from 4 to 33 months. Patient and kidney graft survival were 100%. Kidney function remained stable with a mean estimated glomerular filtration rate of 73.2 ± 25.1 mL/min/1.73 m2 at last follow-up. Six months after the last infusion, C-peptide was detectable in 12 of 13 patients, and 8 of 13 achieved BETA-2 scores >15. Based on Igls criteria, 61% demonstrated optimal or good β-cell function at 6 months. Eight patients (61.5%) achieved insulin independence. Among the remaining patients, 90% maintained hemoglobin A1c <7% with a 75% reduction in insulin requirements. No severe hypoglycemic episodes occurred. Surgical complications were limited to 3 cases of postinfusion bleeding. This series highlights SIK as a feasible option for SPK-ineligible patients, emphasizing durable metabolic benefit rather than insulin independence alone.