*Purpose: Invasive fungal infections (IFI) remain a rare yet dreaded complication following pancreas transplantation. Current guidelines recommend antifungal prophylaxis in patients with 1 or more risk factors (enteric drainage, vascular thrombosis, and post-perfusion pancreatitis). These recommendations are based on a single-center study from 1996. In our center, we provide a single dose of antifungal prophylaxis in the OR but none subsequently, regardless of risk factors. Here we evaluate the 1-year cumulative incidence and risk factors associated with the development of invasive fungal infections

*Methods: We performed a retrospective, single-center cohort study of adult patients who underwent pancreas transplant alone (PTA) or simultaneous kidney-pancreas transplant (SPKT) at Indiana University from January 1, 2009 through December 31,2018. The electronic health records were manually reviewed, and cases were adjudicated using consensus definitions. Only proven and probable cases were included in the analysis. The 1-year cumulative incidence and mortality and risk factors were analyzed by Kaplan-Meier method and differences between patient populations were assessed with Chi-square

*Results: 382 patients were reviewed and analyzed. 215 patients received either a SPKT or pancreas after prior kidney transplant and 167 patients received a PTA. All pancreas allografts are implanted with systemic venous and enteric drainage and patients receive induction with rATG and steroid free maintenance immunosuppression. We identified 14 IFIs. IFI included: Invasive candidiasis (64%), Histoplasmosis (14%) and Aspergillosis (14%). Intrabdominal infections accounted for most IFIs (6/14), bloodstream infections (3/14), disseminated disease (3/14), pulmonary disease (1/14) and invasive fungal sinusitis (1/14). Median time to IFI was 64 days [IQR: 30-234 days]. 1-year cumulative incidence was 3.66%. There were no significant differences between patients with or without IFD regarding type of pancreas transplant (p=0.4), post-transplant renal replacement therapy (p=0.3), rejection (p=0.5), CMV serostatus (p=0.8), or graft-loss (p=0.2). The 1-year mortality in IFI patients was 21% vs 1.4% in non-IFI patients (p<0.0001). Attributable mortality to IFI was 33%

*Conclusions: Our study suggests that the avoidance of fungal prophylaxis following pancreas transplantation does not result in high incidence of IFI. Furthermore, there are no specific risk factors that are associated with the development of invasive fungal infections

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