*Purpose: Early post-transplant, use of oral or enteral medications in pancreas transplant (PTX) is difficult due to NG tubes put to suction. The use of sublingual (SL) tacrolimus (FK) may offer a promising alternative to oral (PO) therapy, but this has yet to be established in PTX. The objective of this study was the compare the clinical pharmacokinetics and peri-operative outcomes between PO and SL FK in PTX.

*Methods: This was a single center, retrospective cohort study of PTX (PTA, SPK or PAK) transplanted between 1/1/2011 to 7/1/18. We switched our FK protocol from PO to SL in PTX in 1/1/2017. Propensity score matching (PSM) was utilized (1:2 ratio, greedy match, no replacement) to develop two comparable cohorts (SL vs PO). Data was analyzed using standard univariate statistical methods.

*Results: A total of 54 PTX recipients were included in the analysis; 17 SL patients were capable of being matched to 37 PO patients. The PSM was successful, as baseline characteristics were similar between groups (Table 1). Within the SL group, it took a mean of 3.2 days to achieve a therapeutic FK trough (≥8 ng/mL) compared to a mean of 3.8 days in the PO group (p=0.175). There was no difference in the incidence of hyperkalemia and supratherapeutic FK levels between groups. Of note, the conversion factor from SL to PO in this patient population was 0.67, slightly different than what has been reported in other transplant populations. Clinical outcomes were similar between groups as well (Table 2).

*Conclusions: SL FK use in PTX appears to be a safe and effective strategy to avoid PO or IV therapy in the peri-operative period, and may lead to reduced time to achieve therapeutic levels.

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