*Purpose: Health disparities in African-Americans (AAs) are well-documented in kidney transplantation. There is a paucity of data regarding effect race in pancreas transplant (PTX) outcomes.

*Methods: Large-scale, single-center, longitudinal cohort study including adult PTX recipients transplanted between 2001 and 2012; follow-up through 2017. Univariate and multivariable analyses were conducted to assess the influence of race on perioperative and long-term outcomes.

*Results: 214 recipients were included, 83 (38.7%) were AA. At baseline, AAs had 2.2 higher odds of receiving a simultaneous kidney (SPK, p=0.018), were more likely to be female and were younger. Perioperative complications requiring reoperation were significantly higher in AAs (32% vs. 17%, p=0.023), primarily due to bleeding, leaks and thrombosis. Other perioperative complications, including pancreatitis and medication complications were similar between groups. Acute rejection of the PTX was similar across AA and non-AAs (12.0% vs. 16.8%, p=0.343). Rejection of the kidney in SPKs tended to be higher in AAs (20.6% vs 11.4%, p=0.113). Long-term mean hemoglobin A1C levels were higher in AAs (7.4% vs. 6.4%, p=0.018). PTX graft survival was similar between AAs and non-AAs (top Figure 1), while patient survival tended to be lower in AA recipients early post-transplant (bottom Figure 1). Multivariable analyses demonstrated that outcome differences were not impacted by baseline transplant type, gender or age.

*Conclusions: The largest single center experience with AAs PTX demonstrates significant perioperative health outcomes disparities and glycemic control after transplant, with more early deaths. However, long-term graft and patient survival in PTX recipients appears to be similar across AA and non-AA recipients.

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