We determined and compared the mortality of pancreas transplant recipients and of patients on the pancreas waiting lists by using United Network for Organ Sharing (UNOS) and International Pancreas Transplant Registry (IPTR) data. From January 1, 1995, through May 31, 2003, a total of 12,478 patients were listed for a simultaneous pancreas-kidney (SPK) transplant; 2942 for a pancreas after (previous) kidney transplant (PAK); and 1207 for a pancreas transplant alone (PTA). In this retrospective observational cohort study, patients with multiple listings at different transplant centers and patients who changed transplant centers were counted only once. The Social Security Death Master File (SSDMF) and the UNOS kidney transplant database were used to update mortality information. By univariate analyses, 4-year patient survival rates on the waiting lists (vs. post-transplant), in the SPK category, were 58.7% (vs. 90.3%); in the PAK category, 81.7% (vs. 88.3%); and in the PTA category, 87.3% (vs. 90.5%). Up to one-third of recipient deaths after post-transplant day 90 were not related to the transplant procedure itself. Multivariate analyses showed that the overall mortality in all three categories was not increased after transplantation (for SPK recipients only, it was significantly decreased). In summary, the mortality for solitary pancreas transplant recipients is not higher than for wait-listed patients.