*Purpose: Hyperglycemia requiring insulin treatment is frequent in critically ill patients and potential pancreas donors. Information on the impact of donor insulin use on pancreas outcomes is scarce. Thus, we explored the influence of donor insulin use on recipient and pancreas graft survival.

*Methods: Retrospective study with 12841 pancreas recipients (either simultaneous pancreas-kidney, pancreas after kidney or pancreas alone) from the OPTN/UNOS registry performed between 2000 and 2017. Multivisceral recipients other than simultaneous pancreas-kidney, those transplants from a donor < 30 kg and recipients with diabetes other than type 1 or 2 were excluded. Insulin donor requirements were defined as the need for any dose of insulin within 24 hours prior to donation.

*Results: A total of 7765 (60%) patients received a pancreas from a donor with insulin requirements. Pancreas graft survival (death-censored) at 1 year was similar between those who received an insulin-requiring donor and the remaining (89% vs 89%, P > 0.05), as well as at 5 and 10 years (78% and 69% vs 79% and 70%, respectively, P = 0.35)(Figure). Donor insulin therapy was not associated neither with an increased risk of recipient death (HR 0.93 [95% CI 0.80-1.07], P = 0.29) nor pancreas graft failure (HR 1.08 [95% CI 0.99-1.17], P = 0.09).

*Conclusions: Insulin requirements in a potential pancreas donor is not associated, per se, with an impaired pancreas graft and patient survival. Thus, donors who require insulin therapy may be suitable for pancreas transplantation.

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