Pancreas transplantation is an important option to those with diabetes. Survival rates and number of pancreas transplants have improved with the advent of newer immunosuppressive agents (tacrolimus and mycophenolate). The median survival for pancreas transplants was approximately 9 years (10 years for SPK recipients). However, at 21-years the survival rate was < 10%. In all, the long-term success of pancreas transplants still has room for improvement. And with a new surge to look for HLA antibodies (8) and potentially to treat or prevent their development, there is hope that survival over the next 20 years will be much improved.