AbstractBackgroundThe risk factors and outcomes associated with post‐ transplant hypotension after simultaneous pancreas and kidney (SPK) Transplantation are poorly defined.MethodsSPK recipients at our center between 2010 and 2021 with functioning pancreas and kidney grafts for >6 months were included. Recipients were then divided into three groups based on active medications for the treatment of hypo‐or hypertension at 6‐months post‐transplant: those with normal blood pressure (NBP) not requiring medication (NBP group), those on antihypertensive medications (HTN group), and those on medications for hypotension (fludrocortisone and/or midodrine) (Hypotensive group).ResultsA total of 306 recipients were included in the study: 54 (18%) in the NBP group, 215 (70%) in the HTN group, and 37 (12%) in the Hypotensive group. On multivariate analysis, the use of T‐depleting induction (aHR = 9.64, p = .0001, 95% Cl = 3.12–29.75), pre‐transplant use of hypotensive medications (aHR = 4.53, p = .0003, 95% Cl = 1.98–10.38), and longer duration of dialysis (aHR = 1.02, p = .01, 95% Cl = 1.00–1.04) were associated with an increased risk of post‐transplant hypotension. Post‐transplant hypotension was not associated with an increased risk of death‐censored kidney or pancreatic allograft failure, or patient death.ConclusionHypotension was common even 6 months post‐SPK transplantation. With appropriate management, hypotension was not associated with detrimental graft or patient outcomes.