Background: There are limited data comparing outcomes with different induction agents in pancreas transplantation.

Methods: We analyzed the records of all patients who underwent simultaneous pancreas- kidney (SPK) or  pancreas transplant alone (PTA) at our institution between 01/01/2011 and 12/31/2017. 

Results: Of 317 pancreas transplant recipients, 191 received induction with a T-depleting agent (139 with anti-thymocyte globulin and 52 with alemtuzumab), and 126 received induction with an IL2R blocker (basiliximab). The mean follow-up post-transplant was 5.2 ± 2.4 years.   There were a total of 12 (4%)  patient deaths,  6 (3%) in the T-depletion group, and 6 (5%) in the IL2R blockade group. Similarly, there were a total of 33 (17%) death censored pancreas graft failures in T-cell depleting group and 22 (17.4%) with IL2R  blockade (p=0.9).  No difference was detected in patient (p=0.3) or pancreas allograft (p=0.8) survival between the two groups. Also, no statistically significant difference was found in pancreas allograft rejection between the two groups (48 vs. 43; p=0.2). On multivariate analysis, history of pancreas rejection (HR=3.47, p=0.0002; 95% Cl 2.02 to 5.93) and history of previously failed pancreas allograft (HR=2.0, p=0.01; 95% Cl 1.18 to 4.46) were associated with increased risk of pancreas allograft loss, but choice of induction was not (HR=0.76, p=0.31; 95% Cl 0.45 to 1.28). Further, on multivariate analysis, HLA-mismatching (HR=1.17, p=0.08; 95% Cl 0.98 to 1.39) and CMV infection after transplant (HR=2.3, p=0.0005; 95% Cl 1.45 to 3.80) were associated with increased risk of pancreas allograft rejection, but choice of induction was not (HR=0.77, p=0.22; 95% Cl 0.73 to 1.10). 

Conclusion: We suggest that IL-2 receptor blockade may be a reasonable choice of induction for pancreas transplant recipients at low immunological risk.