*Purpose: We used the Modified transplant symptom Occurrence and symptom distress scale (MTSOSD) to study side-effects of immunosuppression after Pancreas transplantation (PT) for patients with Type 1 Diabetes (T1D).

*Methods: After IRB approval, we prospectively studied 17 PT recipients (Six Aim 1, 11 Aim 2). Subjects were enrolled within a month of PT and completed 3 visits over a year in Aim 1and were enrolled at least 1 year post PT and completed 2 visits one year apart in Aim 2. All subjects completed MTSOSD at these time points. MTSOSD includes 60 symptoms and is completed for frequency (5 point Likert scale never to always occurring) and distress (5 point Likert scale not at all to very much distressing) of symptoms.

*Results: Aim 1- 6 recipients (3 pancreas transplant alone {PTA}, 2 simultaneous pancreas kidney transplantation {SPK} and 1 Pancreas after kidney, all 6 insulin independent{II}) were 40.2 ± 21 years old, 5F, duration of T1D 24.4 ± 17.4 yrs with 32.8 ± 21.2 days interval from PT. Aim 2-11 (9 PTA, 2SPK, 10 II, 1 insulin treated) recipients were 55.6 ± 10.1 years old, 8F, duration of T1D 33.8 ± 12.2 years, 7.2 ± 5.2 yrs interval from PT. Aim 1- laboratory testing (labs) on all 3 visits (V1, V2 & V3) was satisfactory and similar except for improvement in HbA1c 6.1± 0.8% (V1) to 5.7 ± 0.9 % (V3). At least four side effects were reported by every subject with range 4-35 (Table). In course of 1 year, 5 of 6 experienced at least one grade 4 (very much distressing) symptom. 5 subjects included one on V1, 4 on V2 (all new) and 4 subjects on V3 (3 identical to V2 and one identical to V1). Two subjects out of 4 reporting grade 4 symptoms became insulin treated over the year. No significant difference was observed between visits regarding symptom frequency and distress. For Aim 2- labs were satisfactory and similar at both visits as well. During both V1 and 2, at least one side effect was reported by every subject with range 1-53. In course of 1 year, 5 subjects out of 11 experienced at least one grade 4 symptoms; Three on V1, 4 subjects on V2 (2 new and 2 same as V1). Subject who reported 24 grade 4 symptoms on V1 and 25 on V2 was insulin treated. Significant differences were seen between V1 and 2 for two symptoms “I have felt tired “(decreased, p 0.0239) and “I have been experiencing mood swings” (increased, p 0.0341). Table: MTSOSD symptoms frequency and symptoms distress

*Conclusions: PT recipients tolerate immunosuppression well but report some immunosuppressant related side effects in the first year and subsequently after PT.

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