Introduction: The reported 3-month graft failure rate for pancreas allograft remains high ranging from 7-22%. We report outcomes and experience from a single institution with no technical graft loss.

Method: A retrospective chart review was conducted of patients who underwent pancreas transplant +/- a kidney transplant from 2012-2021 with a maximum follow-up of five years. Information on pancreas and kidney graft failure was obtained and defined by current 2019 Organ Procurement and Transplantation Network (OPTN) criteria.

Results: There were a total 74 patients included. The average age was 47.2 (+/- 9.97) with an average duration of diabetes of 22 years. 35.1% of patients were White, 40.5% Black and 24.3% other. 25% of patients identified as Hispanic. 70% of patients were male and 30% female. 65% of patients had type I diabetes and 35% type II diabetes. Most patients underwent simultaneous pancreas kidney (SPK) transplant (92%). 5.4% had pancreas transplant after kidney (PAK) and 2.7% had a pancreas transplant alone (PTA). The 3-month pancreas and kidney allograft survival was 100%. The 1-year survival for both pancreas and kidney were 97%. 5-year survival for pancreas allograft was 90.4% and 91.8% for kidney allograft. There was no pancreas graft failure due to vascular thrombosis or technical complications. Reasons for failure (n = 8) included post-transplant lymphoproliferative disorder (PTLD), vascular compromise after one year, weight gain with diagnosis of type II diabetes after transplantation for type I diabetes (n= 2), death due to other causes such as burn, graft vs. host disease, chronic obstructive pulmonary disease complications and lung cancer. The causes for kidney graft failure (n=5) included the previous deaths mentioned and PTLD.

Conclusion: We report improved survival after pancreas transplantation with no early vascular thrombosis or technical complications and good pancreas and kidney allograft survival due to optimization of technique in addition to protocolized pre- and post-operative management protocol.