*Purpose: Limited data on indications for and outcomes following allograft pancreatectomy (AP) exist. The purpose of this study was to analyze our single center experience with AP

*Methods: We retrospectively reviewed outcomes in 202 consecutive pancreas transplants in 192 patients; all patients received either rATG (n=76) or alemtuzumab (n=126) induction with tacrolimus/MPA ±steroids. 179 pancreas transplants (89%) were performed with portal-enteric and 23 with systemic-enteric drainage

*Results: Over a 12 year period, we performed 162 simultaneous pancreas-kidney transplants (SPKT), 35 sequential pancreas transplants after kidney (PAK), and 5 pancreas transplants alone (PTA). A total of 186 (92%) pancreas transplants were primary with 16 (8%) retransplants. With a mean follow-up of 5.5 years, a total of 71 (35%) pancreas graft losses occurred, of which 22 (31%) resulted in AP. Overall, AP was performed in 11.5% of patients. Indications for AP were early thrombosis (within 3 months of PT, n=15), late thrombosis (n=2), rejection (n=1), infection (n=1), duodenal fistula (n=1), ruptured pseudoaneurysm (n=1), and at retransplantation (n=1). Rates of AP were 95% for early (<3 months) and 11.8% for late graft loss (p<0.001). Rates of AP were 10.5% in SPKT and 12.5% in solitary PTs, 12.5% in pancreas retransplants compared to 10% in primary PTs, and 13% with systemic-enteric compared to 10% with portal-enteric drainage (all p=NS). With a mean follow-up of 5.5 years in patients with and without AP, respective patient survival (81% versus 87%) and kidney graft survival (67% versus 76%) rates were comparable. There were no early deaths or kidney graft losses following AP. When comparing outcomes before and after 2009, the incidence of early AP has decreased from 10.8% to 4.8% (p=NS). Eleven patients underwent successful pancreas retransplantation following AP

*Conclusions: AP is most commonly performed for early graft loss due to thrombosis with no significant differences found between number, type or technique of pancreas transplant. In addition, AP does not appear to adversely influence medium-term patient or kidney graft survival rates or preclude successful pancreas retransplantation.

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