*Purpose: Pancreas transplant is considered as an effective treatment strategy to restore long-term euglycemia and stabilize the multiorgan complications. By June 2019, our center performed more than 400 cases of pancreas transplantation and this represents the largest volume for a single institution in the Korea. In this study, we analyze the graft outcomes and risk factors according to era based on the number of cases.

*Methods: We reviewed 400 cases of pancreas transplantation which performed from July 1992 to June 2018. Patients were divided into groups based on every 100 cases and we compared survival outcomes and demographics between each groups.

*Results: During the period, 178 (44.5%), 134 (33.5%), 47 (11.8%) and 41 (10.2%) patients underwent SPK, PTA, PAK, and SPLK, respectively. Patient survival at 1, 3, 5, and 10 years was 97.1%, 94.6%, 92.9%, and 90.6%. Overall graft survival was 88.9%, 80.6%, 75.4%, and 66.7%, respectively. And death-censored graft survival was 90.1%, 83.1%, 78.5%, and 69.9%, respectively. Based on the operation type, SPK showed the highest patient and graft survival significantly. In multivariate analysis, bladder drainage and history of pancreas graft rejection were a risk factors for graft failure (p=0.034 and 0.00). The Era 1(1-100) showed the lowest (77.6%) and the Era 4(301-400) showed the second lowest (89.8%) graft survival at 1 year after transplant. When, we compared the clinical characteristics between Era2, 3, and 4, thrombosis, thrombectomy, and pancreas rejection history were more common in Era 4(50%, 11%, and 20%, respectively), when we excluded Era 1. The largest portion of cause of graft failure was chronic rejection (33.9%, 538%, and 60.0%) in Era 1, 2, and 3. However, thrombosis rate was significantly increased up to 45.5% in Era 4(p=0.015).

*Conclusions: Pancreas transplantation can be performed safely with excellent outcomes as an effective treatment option for patients for DM. However, the recipients with history of thrombosis, thrombectomy, and rejection treatment are needed caution and close monitoring for maintaining the graft function.

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