*Purpose: Transplant surgery advanced practice providers (APPs) roles and responsibilities vary widely between different transplant centers. In an effort to standardize care for the pancreas transplant program, our center underwent a programmatic transition in mid-2011, in which APPs increased involvement in the daily care of simultaneous pancreas and kidney (SPK), pancreas after kidney (PAK), and pancreas transplant alone (PTA) recipients. We sought to determine if this change impacted patient outcomes.

*Methods: We conducted a retrospective analysis of all patients who underwent SPK, PAK, or PTA at our center between 2006-2017. Patients transplanted during the gradual transition period of increased APP involvement (Feb-Aug 2011) were omitted from analysis (n=6). Cohorts were defined as pre-transition (transplanted before Feb-2011) or post-transition (transplanted after Aug-2011). Primary outcome was index hospital length of stay (LOS). Secondary outcomes were readmission within 30 days of discharge, pancreas graft loss, and patient death. Mann-Whitney U testing was used to compare the primary outcome and 30-day readmissions. Cox proportional hazard testing was used to analyze graft loss and patient death.

*Results: We identified 170 patients during the study period; 106 (62.4%) were pre-transition and 64 (37.6%) were post-transition. There were no significant differences in demographics between cohorts. There was a trend towards lower index hospital LOS for post-transition patients (Figure 1), but this was not statistically significant (8.0±4.1 vs 9.3±7.5 days, p=0.088). No recipients experienced an index hospital LOS ≥21 days in the post-transition period. There were no differences in 30-day hospital readmissions (44.3 vs 42.2%, p=0.8), pancreas graft loss (HR 0.69, 95%CI 0.32-1.49, p=0.3), or patient death (HR 0.98, 95%CI 0.30-3.15, p=1.0).

*Conclusions: Although our study found a trend towards decreased index hospital LOS, this difference was not statistically significant. Despite this trend, there was not an increase in readmissions. Intriguingly, there were fewer outliers in the post transition period, with no patients experiencing index hospital LOS ≥21 days. These results suggest advanced practice providers are effective in standardizing care of pancreas transplant recipients, while maintaining outcomes and potentially positively impacting program metrics.

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