*Purpose: Patients with diabetes mellitus can experience microvascular complications resulting in end organ damage ultimately necessitating pancreatic transplantation. While there is well documented improvement in outcomes and survival in these patients, one issue that lingers is the need for diabetic medications in some of these recipients despite at-goal serum C-peptide levels. The aim of this review is to determine the prevalence of re-initiation of diabetic medications post-transplant and identify risk factors associated with this outcome.

*Methods: This is a single center retrospective cohort review of 26 adult patients – 20 with simultaneous pancreas and kidney transplantation (SPK) and 6 with pancreas after kidney transplantation (PAK) – between January 2012 and December 2017 with a mean follow up period of 2.9 years. The immunosuppressive regimen included tacrolimus, mycophenolate and prednisone. Important metabolic factors were assessed both pre and post-transplantation, including body mass index (BMI), C-peptide, amylase, lipase and lipid panel. Statistical analysis was performed using the analysis of variance (ANOVA) and the cox regression model.

*Results: The demographic of the cohort was as follows: 65% men and 35% women, of which 35% Hispanic, 35% Caucasian, 26% African American and 4% Asian. One of the patients developed graft rejection 1 year post-transplant. Five patients were on diabetic medications with a mean C-peptide of 3.4 ng/mL 12 months post-transplant (vs 2.4 ng/mL in the remainder of the cohort). ANOVA between patients who required initiation of diabetic medications post-transplant compared to those who did not revealed a statistically significant difference when comparing their 12 month post-transplant C-peptide levels (p = 0.019). Cox regression analysis revealed a statistically significant difference between the two groups in the post-transplant BMI both at 6 and 12 months when adjusted for the pre-transplant BMI (p = 0.033). No statistically significant difference was found with the remaining metabolic factors.

*Conclusions: Our study demonstrates that elevated BMI in pancreas transplant recipients with exemplary metabolic graft function is associated with poor metabolic control necessitating re-initiation of diabetic medications. Traditionally, attention has been paid to the patients’ C-peptide, hemoglobin A1c, amylase and lipase levels. As a result, the role of post-transplant dietary and weight monitoring should take center stage when following up with these patients.

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