In the US, a retrospective analysis of OPTN registries compared 8.850 SPK from young donors vs. 776 SPK from donors >45 years. It showed that patients transplanted from an older donor have equal survival compared to those who were waiting for a young donor for more than 1.5 years. However the earlier transplanted patient is instantly off dialysis and insulin. Good results were already achieved with extended pancreas donors in the US and also in one German study.