*Purpose: To identify a post-operative hematocrit (Hct) target for patients recovering from simultaneous kidney and pancreas (SPK) transplant and pancreas transplant alone (PTA) that is associated with optimal outcomes. The use of restrictive transfusion thresholds (Hct 21 -24) have been shown to provide superior outcomes in numerous patient populations. However, patients recovering from SPK and PTA face several challenges not often considered in most other surgical patients. Many SPK recipients are chronically ill with complications of diabetes (including coronary artery disease) in addition to their renal failure. Furthermore, the need to initiate immunosuppression in the post-op period can pose challenges specific to this group of patients. Data regarding optimal transfusion thresholds in SPK transplant and PTA patients are lacking.

*Methods: A retrospective review of all pancreas transplants (SPK and PTA) preformed at the University of Wisconsin Hospital between Jan 2010 and Dec 2016 was performed. Patient demographics, transplant characteristics, complications, blood transfusion and lab results were collected. Hct at the time of primary surgical discharge was correlated with 30-day post-op re-admission, transfusion within 30 days, graft rejection and graft and patient survival.

*Results: During the seven-year time period, 263 SPK transplantations were performed with an average post-operative transfusion rate of 49%. No restrictive red blood cell (RBC) transfusion thresholds were present during the study period. At time of discharge, 21 patients had a Hct ≤24, 122 patients had a Hct between 25-29, and 119 patients had a Hct ≥30. Patients with a Hct ≤24 had significantly higher rates of receiving a blood transfusion within 30 days after discharge (chi-squared, p=0.0007). However, there were no differences in the rate of re-admission within 30 days (chi-squared, p=0.35) or pancreas graft rejection between all three groups. Similarly, graft survival was similar between all three Hct groups (log-rank, p=0.57). The proportion of PTA and SPK in each Hct group were not significantly different (chi-squared, p=0.10).

*Conclusions: We found there were no significant differences in re-admission, pancreas graft rejection or graft survival between pancreas transplant recipients with Hct ≤24, 24-29, or ≥30. However, there was a higher rate of post-discharge blood transfusion in the Hct ≤24 group. Adherence to restrictive transfusion strategies has proven successful in a variety of clinical settings by significantly reducing the number of RBC units being transfused without deleterious effects on patient outcomes. However, the optimal transfusion threshold for SPK recipients has not been well described. Our results demonstrate that adopting a threshold Hct of 24 for RBC transfusion in PTA and SPK patients may be appropriate.

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