*Purpose: Pancreas transplantation is a durable option for patients with insulin dependent diabetes. However, geographic inequity has created a supply side problem for our region. As such, our center implemented a pancreas graft importation policy to increase donor availability and shorten waitlist times for our patients.

*Methods: The study comprised of a single center retrospective cohort of 47 patients who received simultaneous pancreas-kidney (SPK) or pancreas after kidney (PAK) over five years. Donor service area and regional waitlist times were assessed, and outcomes metrics were detailed.

*Results: Aggressive importation increased the amount of imported pancreata from 43 percent in 2014 to 86 percent in 2018 (Figure 1. Panel A). Waitlist times decreased drastically from a median of 1470 days (range: 345 – 2425) in 2014 to 514 days (range: 18 – 2318) in 2018 (Figure 1); p=0.11. Mean follow up time was 780 days. There was one graft loss and one patient death. Waitlist times (days) at MMC (total = 526, SPK = 518, PAK = 546) approached the national median (total = 511, SPK = 572, PAK = 225; p=NS) and were well below Region 9 (total = 915, SPK = 980, PAK = 528; p=0.12, p=0.01, p=0.92), (Figure 1. Panel B).

*Conclusions: Centers disadvantaged by donor service area and regional allocation must implement pancreata importation to address long waitlist times.

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