*Purpose: About 10% of pancreas allografts are lost prematurely due to thrombosis. Despite identification of numerous risk factors, the incidence of early failure did not change throughout time.

*Methods: We conducted a multicentric study including 874 pancreas transplantations in 4 French centers between 2000 and 2018. Donor, recipient and perioperative transplantation characteristics were analysed among patients with early failure (occurring first month) and with functional allograft at one year. Multiple logistic regression analyses and survival curves were determined by Cox models.

*Results: Documented donor hypertension was significantly higher among patients in the failure group (11.6% vs 4.6%, p = 0.007). Donor hypertension was the single risk factor of early failure after evaluation by multivariate analysis (OR=2.75; 95IC%= [1.07; 6.78]; p=0.03). Donor hypertension was correlated with a significant decrease of pancreas and patient survival (respectively, p=0.003 and p=0.0007). These differences persisted after adjustments regarding recipient gender, donor age, donor abdominal perimeter, donor BMI and donor dyslipidemia. Cause of early graft failure were mostly vein thrombosis (83.7%). Simultaneous kidney transplantation from a hypertensive donor showed significant worst function on pod 7 (eGFR= 60.7 vs 40.7 ml/min; p=0.01) and persisted at one year (eGFR= 63.1 vs 43.7 ml/min; p < 0.001). Kidney graft survival was also lower in case of documented donor hypertension.

*Conclusions: Donor hypertension was a risk factor for early pancreas failure, decreased pancreas and patient survival and worst kidney function after SPK transplantation.

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