Diabetes mellitus (DM) is the leading cause of end-stage renal disease in the United States. The treatment of choice for patients with diabetic nephropathy is a simultaneous pancreas-kidney (SPK) transplant. Obesity negatively impacts posttransplant patients through increased infection rates, graft loss, and death. To prevent such complications, bariatric surgery has been successfully used and reported in the surgical literature. We describe a case of laparoscopic vertical sleeve gastrectomy (LSG) after an SPK transplant in a morbidly obese patient. To our knowledge, this is the first such reported case in the English language surgical literature.