*Purpose: Pancreas transplant thrombosis is the most common cause of graft failure in the early postoperative period, occurring 5-20% of cases. Bleeding (which occurs ~30% of cases) is manageable, while thrombosis near universally leads to graft loss. The aim of this study is to see if use of a perioperative anticoagulation protocol can decrease graft thrombosis.

*Methods: This retrospective, single center analysis of all patients who underwent pancreas transplantation at VMMC in 2006-2019 evaluates use of our perioperative anticoagulation protocol, enacted in 2011. Clinical outcomes included hospital LOS, 30 day readmission, pancreatic thrombosis, units of PRBCs transfused, hematoma, reoperation, pancreas graft survival at 1 and 3 years, and patient overall survival at 1 and 3 years. Chi² analyses were performed for categorical variables, and unpaired t-tests were performed for variables of means.

*Results: 107 patients were included, 77 in the anticoagulated (AC) group. Pancreas graft thrombosis is lower in the AC group (6.5% vs. 20%, p=0.0388). The AC group also has a pancreas graft survival benefit at 1 year (92.1% vs. 71.4%, p=0.0061). There is no increased risk of postoperative complications in the AC group compared to the non-AC group, namely hematoma (7.8% vs. 0%, p=0.1156), units of PRBCs transfused (1.4±2.3 vs. 0.8±1.8, p=0.1861), reoperation (24.7% vs. 20%, p=0.6077), or 30 day readmission (45.5% vs. 43.4%, p=0.8429). There were no significant differences between cohort demographics or operative factors such as ischemia/anastomosis times.

*Conclusions: Postoperative anticoagulation is a promising method for reduction of pancreas graft thrombosis and may increase the rate of pancreas graft survival at 1 year. Importantly, there are no negative repercussions on postoperative morbidity or mortality.

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