A 47- year- old female patient with end- stage renal disease secondary to type 1 diabetes underwent a simultaneous pancreas– kidney (SPK) transplantation in 2016, 9 years after a living- donor kidney trans-plantation. The first kidney graft, implanted extraperitoneally in the left iliac fossa, was not removed during SPK. SPK was performed intraperitoneally with the second kidney implanted on the left com-mon iliac artery and the pancreas on the right, with portal- enteric drainage.