Compared to the still increasing number of kidney, liver and heart transplants performed worldwide, pancreas transplantation remains a rare occurrence. At our center a pancreas transplant program was began in late 1979. Since then a total of 113 pancreas transplants were performed in 106 patients, 100 of them also received a kidney from the same donor. The first group consisted of 5 patients with immediate duct occlusion (IDO). In the second group (n = 8) the pancreatic juice of the segmental graft was diverted into a Roux-Y loop of jejunum. Because of two fatal technique-associated complications, delayed duct occlusion was introduced and applied in 15 patients. Because of a prolonged hospitalization period due to local complications, the surgical technique was changed again. From 1987, 72 segmental pancreatic transplants with bladder drainage were performed and finally one whole organ with a duodenal segment was transplanted. Immunosuppression consisted of cyclosporine A, azathioprine and prednisolone from 1984 on. Rejection episodes were treated with a high-dose methylprednisolone on 3 consecutive days and steroid-resistant rejections with ATG. The overall patient survival at 6 years was 80%, renal allograft survival 72% and pancreas graft survival 63% for the entire group. In the delayed duct occlusion group, 1-year patient and kidney graft survival of 93% each and 79% for the pancreas was calculated. One-year survival in the most recent and largest group with bladder drainage was 89% for patients, 86% for the kidney and 75% for the pancreas. Excellent metabolic control was achieved in the majority of patients with mean C-peptide levels and HbA1C levels at 6 months of 1.46 pmol/ml and 5.6%, respectively. Successful pancreas transplants with normalization of carbohydrate metabolism seem to have a beneficial effect on secondary complications of diabetes, contributing to the high degree of rehabilitation of these patients.