Pancreas transplantation has emerged asthe single most effective way to achieve normal glucose homeostasis inpatients with type I insulin-dependent diabetes mellitus. Optimalimmunosuppressive strategies for pancreas transplantation continue toevolve with the use of newer, more potent immunosuppressive agents,particularly tacrolimus, mycophenolate mofetil, and rapamycin. Theseagents have contributed to substantially lower rates of allograftrejection and improved graft survival. Regimens designed to avoidnephrotoxicity or spare corticosteroid therapy are emerging as thevariety of drug options grows. Also contributing to progressivelybetter results for solitary pancreas transplants are reductions inearly graft loss rates and the development of safe, effective biopsytechniques, permitting accurate diagnosis of rejection. Collectively,these factors have allowed solitary pancreas allograft recipients, agroup of patients with historically poor long-term graft survival, toenjoy successes nearly equivalent to those of combined kidney-pancreastransplants. Consequently, the American Diabetes Association stronglyendorses pancreas transplantation in diabetic patients who havereceived prior kidney transplants and who have life-threateningmetabolic lability.