Among other complications, diabetes mellitus leads to peripheral vascular disease with the risk of limb amputation. This retrospective study analyzed the incidence of amputations after simultaneous pancreas-kidney transplantation (SPK). Between June 1994 and February 2001, 200 SPKs, nine pancreas-after-kidney- (PAK) and one pancreas transplantation alone (PTA) were performed. The overall 5-year patient, pancreas-, and kidney-graft survival rates were 92.4%, 80.2% and 85.6%, respectively. Mean age at transplantation was 38.7 years, mean duration of diabetes was 26.9 years, mean duration of dialysis was 26.7 months. Nineteen (9.5%) patients after SPK (seven female/12 male) underwent 33 amputations, on average 18.7 months after transplantation. Longer duration of dialysis and a previous history of amputation were significant risk factors for an amputation after SPK (P=0.014, P<0.001). Thus, early referral for SPK before dialysis initiation may be beneficial in preventing amputation.