*Purpose: While outcomes of pancreas transplants are improving, there is a persistent hesitancy to use pancreas organs procured in the context of donation after cardiac death (DCD) for pancreas transplant alone (PTA) because of concern of graft thrombosis and primary non-function organs. We report the outcomes of the first 43 DCD PTA in the United States.

*Methods: We examined Organ Procurement and Transplantation Network (OPTN) data for patients with type 1 diabetes mellitus (T1DM) who received PTA from donation after brain death (DBD, n= 1906) and DCD (n= 43) from January 2002 to December 2016. Associations of transplant type with all-cause graft failure and patient death (adjusted hazard ratio, 95% _LCL aHR 95% _UCL) were quantified by multivariate Cox regression including adjustment for recipient, donor, and transplant factors.

*Results: The average number of PTA declined from 145 per year in 2002-2008, to 112 per year in 2009-2016 (Figure 1). Region 7 performed the highest number of PTA (582 DBD, 26 DCD), followed by Regions 10 (413 DBD, 4 DCD), 2 (DBD 325, 2 DCD) and 3 (DBD 63, 0 DCD). Pancreas graft survival of DCD PTA was not significantly different than DBD at 1 year (75% vs 75%), 3 years (60 vs. 64%), and 5 years follow-up (50 vs 55%) (P=0.79) (Figure 2). Compared to DBD PTA, recipients of DCD PTA did not have a significant increase of risk of pancreas failure (aHR _0.751.22_1.99) or patient death (aHR _0.360.91_2.31).

*Conclusions: These data support that selected DCD PTA by experienced surgeons may be a successful option for pancreas transplantation, offering equivalent outcomes as pancreata procured after brain death.

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