As of November 1998, more than 11,000 pancreas transplants had been reported to the IPTR, including more than 8,800 US and more than 2,600 non-US cases. The 1994-98 cases (> 4,500) were analyzed, including more than 4,000 US and more than 500 non-US transplants. For all US 1994-98 SPK transplants (n = 3,409), one-year patient, pancreas and kidney graft survival rates were 94%, 90% and 83%, respectively; for all PAK cases (n = 375), one-year patient and graft survival rates were 95% and 71%; and for all PTA cases (n = 181), one-year patient and graft survival rates were 95% and 64%, respectively. Recipient age had only a small impact on outcome, with one-year patient survival rates for all recipients < 45 years of 95% (n = 3,215) versus 91% for those > or = 45 years old (n = 758) (p = 0.005). Pancreas graft survival rates at one year for those < 45 versus > or = 45 years old were 84% versus 78% in the SPK (p < 0.02), 70% versus 78% in the PAK (p = 0.13), and 62% versus 79% in the PTA (p = 0.23) categories, respectively). Nearly one-third of US pancreas transplants for 1994-98 were done by the ED drainage technique. For SPK transplants, the one-year pancreas graft survival rate was 83% for BD (n = 2,369) and 82% for ED (n = 912) (p < or = 0.09). For PAK and PTA transplants, pancreas graft survival rates were significantly higher with BD, 74% (n = 261) and 68% (n = 115), respectively, at one year. The drawback for BD was the need for conversion to ED in 7% of the cases at one year and 11% at 2 years. For TS transplants, the pancreas graft loss due to rejection was very low for SPK transplants, 2% at one year versus 9% for PAK and 15% for PTA cases. The various initial maintenance immunosuppressive regimens (Tac + MMF, Tac + Aza, CsA + MMF, CsA + Aza) resulted in only minor differences in pancreas graft survival rates in the SPK cases (80-86% at 1 year), but in PAK and PTA cases the Tac + MMF combination was associated with significantly higher pancreas graft survival rates. For BD PAK transplant recipients given Tac + MMF, the one-year pancreas graft survival rate was 83% (n = 100). For the corresponding BD PTA group it was 75% (n = 44). For non-US cases the outcomes were similar. For non-US SPK transplants (n = 586), one-year patient, kidney and pancreas graft survival rates were 93%, 85% and 81%, respectively. Cox multivariate analyses and logistical regression were done in each recipient category to assess the factors that influence pancreas graft loss. BD was associated with a significantly lower risk than ED in all categories. Increasing donor age was a risk factor in most categories. MMF was associated with a decreased risk for graft loss in the SPK category, and Tac in the PAK and PTA categories.