Chronic rejection has remained the Achilles heel in improving the long-term graft survival in pancreas transplants. A single center retrospective analysis of outcomes was performed to determine if HLA mismatches were associated with graft loss due to chronic rejection. In this study, we analyzed all simultaneous kidney-pancreas transplants performed at our center between January 2000 to January 2011. Patients with functioning grafts (FG) were compared to those with grafts lost due to chronic rejection (CRG) with respect to their HLA A, B and DR matches and mismatches. Of the 112 kidney pancreas recipients, 72 recipients (64%) had functioning graft at more than 10 year follow up. 28 patients (25%) lost their graft to chronic rejection. Twelve recipients (11%) with failed grafts due to surgical or infectious complications were excluded from the study. The recipients with graft loss due to chronic rejection (CRG) were slightly younger (mean age 37 in comparison to 42) than recipients with functioning grafts (FG). Both groups had similar mean BMI of 25. Mean pancreas preservation time in FG and CRG groups were 12.5 and 12 hours respectively. The mean HLA A, B and DR mismatches in FG group (1.43,1.58,1.34) was comparable to those in CRG group (1.46,1.5,1.53). The mean total HLA mismatches in the FG and CRG groups were 4.36 and 4.5 respectively. Our data does not support the use of HLA matching to predict pancreas graft loss due to chronic rejection in simultaneous kidney pancreas transplant recipients.