We analyzed 752 simultaneous pancreas kidney transplants performed at the University of Wisconsin from December 1985-February 2003. Patient survival rates at 5 and 10 years were 88% and 77%. The 5- and 10-year pancreas survival rates were 78% and 61% and the corresponding kidney survival rates were 80% and 59%. In this limited retrospective analysis of outcomes after simultaneous pancreas-kidney transplantation, the importance of donor selection is re-emphasized. Donor age and donor BMI significantly impact on graft and recipient survival. Furthermore, complications following SPK transplantation negatively impact on outcomes.