*Purpose: Pancreas transplantation is an established treatment for diabetic patients with end-stage renal disease. Graft outcomes have improved in the last decades, but data regarding patient and graft outcomes is mainly derived from registries or prospective single centre studies.

*Methods: We conducted a retrospective, longitudinal, multicentre study to assess risk factors that impact on patient and graft survival in pancreas transplant recipients between January 2008 and December 2012 in 8 centres in Spain. Both simultaneous pancreas-kidney (SPK), pancreas-after-kidney (PAK), and pancreas transplant alone (PTA) were included. Data were collected from until 31 December 2015.

*Results: A total of 301 patients were included during the study period. The majority had diabetes mellitus type I (96.7%) for a mean (±standard deviation) time until transplantation of 26.1 years (±7.48). A total of 282 patients (93.7%) survived from transplantation until the end of study, and 19 patients died owing mostly to infections (n=10). Among 55 patients (18.3%) with pancreas graft loss, the main reasons were vascular thrombosis (n=19), chronic rejection (n=10), acute rejection (n=6), and death with a functioning graft (n=5). There were no clear risk factors identified for patient survival, and the rate of cardiovascular-related deaths was 6.3% at 5 years post-transplant. Graft survival was superior in SPK recipients when compared to pancreas alone (either PAK or PTA). Glycaemia, serum creatinine, and control of traditional cardiovascular risk factors was optimal at follow-up.

*Conclusions: This multicenter study highlight the excellent patient and pancreas graft outcomes in pancreas transplantation, with a notably low incidence of cardiovascular events

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