Simultaneous pancreas and kidney transplants (SPKs) from cadaver donors have become a widely accepted treatment option for insulin-dependent (Type I diabetic) patients with end-stage nephropathy. However, for technically successful transplants, long-term success is better with living donors (LDs). Sequential kidney and pancreas transplants from LDs have been done, but until now SPKs from LDs have not been attempted. We report here 2 successful SPKs from LDs. Both recipients received a right kidney and distal pancreas: the first (a 28-year-old woman, diabetic since age 7) from her 54-year-old mother; the second (a 46-year-old man, diabetic since age 31) from his 44-year-old sister. Six months posttransplant both recipients have function of both grafts (serum creatinine < or = to 1.5 mg/dl; serum C-peptide normal range, fasting and stimulated). Thus, SPKs from LDs are technically feasible and could be an alternative to segmental transplants or cadaver SPKs for selected type I diabetic patients with end-stage nephropathy.