*Purpose: African-American recipients (AA) are considered a high risk group for organ transplantation. As outcomes after pancreas transplantation have significantly improved, the number of transplants in AA have increased considerably. However, no recent outcome information is available.

*Methods: We studied 1,692 primary deceased donor pancreas transplants in AA between 1/2008 and 12/2017. The majority of transplants were simultaneous pancreas/kidney (SPK) transplants (91.2%) followed by Pancreas after Kidney transplants (7.2%). Pancreas transplants alone were rarely performed and accounted for 1.6%. This study concentrates on SPK transplants. Univariate and multivariate methods were used to study outcome and potential donor and recipient risk factors.

*Results: During the analyzed time period the number of pancreas transplants in AA increased significantly from 15% in 2008 to 25% of all pancreas transplants 2017.The indication for SPK transplant was in 83 % type 1 and in 17% type 2 diabetes mellitus (DM); 36% of the recipients were female. About 50% of recipients were overweight or obese and recipients with type 2 DM were significantly more likely to be obese or overweight. Patient survival remained stable over time and reached at 1- (5-)-year 97% (89%). The highest impact on patient survival was a functioning kidney and/or pancreas graft. In addition, each additional year on dialysis pretransplant increased the relative risk (RR) to die by 15%. Younger and older age had a negative impact on patient survival. Diabetes type proved to be non-significant. Pancreas graft functions at 1- (5-) years was 89% (75%). The most influential factor for graft failure was obesity (RR:1.50, p=0.006). Only a slight correlation between type 2 DM and BMI was found where being obese had the higher impact. A cPRA over 20% also significantly increased the risk of pancreas graft failure. In contrast, younger donors and large transplant centers showed significantly better outcomes. Immunologic pancreas graft loss at 1- (5)-year was 2% (11%). Main risk factors were younger recipient age, no use of depleting antibody therapy for induction, early treatment for rejection and 2 antigen HLA B-mismatches. Kidney graft survival at 1- (5-) was 95% (78%). Donor and recipient age, obesity and gender had a significant impact on kidney graft survival. The use of enteric drainage significantly lowered the risk of kidney graft loss.

*Conclusions: This study shows that pancreas transplantation is associated with excellent outcome in AA recipients and should be made available for this group of patients.

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