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Introduction Kidney and simultaneous pancreas kidney (SPK) transplant recipients are younger and fitter than most other dialysis patients, but are also more vulnerable in areas of social, emotional and physical interaction. Few studies have tracked their post‐transplant health‐related quality of life (HRQoL). Aim To assess HRQoL following kidney and SPK transplantation, with comparison to dialysis patients, people with multiple co‐morbidities and general population data. Methods Patients completed the Kidney Disease Quality of Life Short Form (KDQOL‐SF™) 1.3 to assess their pre‐transplant HRQoL within 4 weeks of transplantation and 12 months later. Demographic and laboratory data were collected on participating patients and on non‐participating patients at both time‐points. Results Of 118 patients who completed the baseline KDQOL‐SF™, 75 (57 kidney and 18 SPK) completed the 1 year survey. Compared to baseline, 12 months HRQoL scores improved in all domains except for work status, exceeded those of patients on dialysis and, except for emotional wellbeing and mental health, exceeded the scores of people with multiple co‐morbidities. For female transplant recipients, 12 months HRQoL scores were not statistically different from similarly aged women in the general population. Male transplant recipients had similar scores for bodily pain and energy/fatigue, but lower scores in other domains. Compared to kidney‐only transplant recipients, SPK recipients achieved higher scores in work and sleep domains. Conclusion Improvements in most HRQoL domains occur within 1 year of kidney or SPK transplantation, and women achieve similar HRQoL to women in the general population. These data are encouraging for patients contemplating transplant listing.

word count: 246 16 Word count: 3110 Abstract 34 Background: Cardiovascular (CV) disease is the leading cause of death in kidney and 35 simultaneous pancreas-kidney (SPK) transplant recipients. Assessing abdominal aortic 36 calcification (AAC), using lateral spine x-rays and the Kaupilla 24-point AAC (0-24) score, 37 may identify transplant recipients at higher CV risk. 38 Methods: Between the years 2000-2015, 413 kidney and 213 SPK first transplant recipients 39 were scored for AAC at time of transplant and then followed for CV events (coronary heart, 40 cerebrovascular or peripheral vascular disease), graft-loss and all-cause mortality. 41 Results: The mean age was 44 ± 12 years (SD) with 275 (44%) having AAC (26% moderate: 42 1-7 and 18% high: ≥8). After a median of 65 months (IQR 29-107 months), 46 recipient's 43 experienced CV events, 59 died and 80 suffered graft loss. For each point increase in AAC, 44the unadjusted hazard ratios (HR) for CV events and mortality were 1.11 (95% CI 1.07-1.15) 45 and 1.11 (1.08-1.15). These were similar after adjusting for age, gender, smoking, transplant 46 type, dialysis vintage and diabetes: aHR 1.07 (95% CI 1.02-1.12) and 1.09 (1.04-1.13). For 47 recipients with high versus no AAC, the unadjusted and fully-adjusted HR for CV events 48 were 5.90 (2.90-12.02) and 3.51 (1.54-8.00), for deaths 5.39 (3.00-9.68) and 3.38 (1.71-6.70), 49 and for graft loss 1.30 (0.75-2.28) and 1.94 (1.04-3.27) in age and smoking history-adjusted 50 analyses. 51 Conclusion: Kidney and SPK transplant recipients with high AAC have 3-fold higher CV 52 and mortality risk and poorer graft outcomes than recipients without AAC. AAC scoring may 53 be useful in assessing and targeted risk-lowering strategies. 54 55 56 KEY WORDS; vascular calcification, cardiovascular disease, kidney transplant, 57 simultaneous pancreas-kidney transplant, mortality.

Younger, fitter patients are more vulnerable to effects of their illness on social, emotional and physical interactions and may benefit from targeted support.

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