*Purpose: Early pancreas allograft failure most commonly results from vascular thrombosis. Immediate surgical intervention may permit pancreas allograft salvage, typically requiring thrombectomy. In cases of partial allograft necrosis secondary to splenic arterial thrombosis, distal allograft pancreatectomy may allow salvage of at least half of the pancreas allograft with retention of function.

*Methods: The medical records for all adult patients who underwent deceased-donor pancreas transplantation at Indiana University Health University Hospital between January 2003 to October 2020 were retrospectively reviewed. Data came from the transplant recipient registry at our center and from individual electronic medical records. Simultaneous pancreas and kidney transplantation (SPK), pancreas after kidney transplantation (PAK), and pancreas transplantation alone (PTA) recipients were included.

*Results: There were 710 pancreas transplants performed at Indiana University Health University Hospital between January 2003 and October 2020. During this period, four cases required distal allograft pancreatectomy for splenic artery thrombosis with necrosis of the distal pancreas. All four were SPK recipients. Their cases including post-transplant courses, are described in detail and summarized in Table 1. Three of the four maintained long-term allograft function with euglycemia independent of insulin at six months to six years of follow-up, and all patients continue to maintain normal renal allograft function.

*Conclusions: Early diagnosis and early intervention are essential in order to salvage the pancreas allograft in the case of thrombosis. Distal allograft pancreatectomy can be performed safely and result in excellent long-term outcomes in select patients.

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