Background: Many transplant (tx) programs are reluctant to import pancreas allografts because of concerns that outcomes might be inferior to locally procured organs. Methods: Single center retrospective review of 202 pancreas txs from 11/14/01-2/19/13. All patients (pts) received T-cell depleting antibody and FK/ MMF/steroids. Results: 162 kidney-pancreas (KP) and 40 solitary pancreas (SP) txs were performed; 160 were local (LOC) and 42 were imported (IMP) organs. Median f/u was 7 years. SP recipients were more likely to receive an IMP organ compared to KP recipients (47% SP vs 14% KP, p<0.001). Recipient age, gender, and ethnicity were comparable between IMP and LOC pancreas recipients. Donor ethnicity, history of hypertension, cause of death, and BMI were also comparable between IMP and LOC pancreas recipients. IMP organs came from younger donors (IMP mean 23 vs LOC 27 yrs, p=0.04) with longer pancreas CIT (IMP mean 17.3 vs LOC 15.6 hrs, p=0.02), higher terminal serum creatinine (IMP mean 1.2 vs LOC 1.0 mg/dl, p=0.02), fewer HLA mismatches (IMP mean 3.5 vs LOC 4.3, p=0.001), and less frequent pressor use (IMP 45% vs LOC 64%, p=0.03). One-, 3-, and 5-year actuarial kidney graft (KG) survival (IMP 95%, 93%, 83% vs LOC 97%, 87%, 80%), pancreas graft (PG) survival (IMP 83%, 63%, 58% vs LOC 87%, 82%, 72%), and pt survival (IMP 98%, 95%, 89% vs LOC 97%, 95%, 92%, all p=NS) rates were comparable between recipients of IMP and LOC organs. Whereas actuarial PG survival was similar in SP recipients from IMP and LOC donors, it was significantly worse in KP recipients from IMP donors; 1-, 3-, and 5-year PG survival for IMP was 78%, 56%, 45% vs. LOC 87%, 82%, 73%, p=0.013. Actual IMP PG failure rate in KP recipients was 61% vs 37% for LOC PG recipients, p=0.028. Technical and non-technical causes of PG failure were similar in recipients of organs from IMP and LOC donors. Inferior actuarial PG survival in KP recipients from IMP donors persisted with death censored analysis. Conclusion: While comparable overall results can be achieved using organs from IMP and LOC pancreas donors, caution and careful donor selection is paramount. Inferior PG survival in KP recipients from IMP donors, despite comparable donor and recipient demographics and similar causes of PG failure in recipients of IMP and LOC organs, may be a result of longer pancreas CIT or unidentified donor or procurement variables that may affect PG survival.

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