Patient and graft survival rates after combined kidney and pancreas transplantation continue to improve. Percutaneous and cystoscopic pancreas biopsies are safe and aid in the diagnosis of acute rejection. Primary enteric drainage of pancreatic exocrine secretions is being re-evaluated to avoid the morbidity associated with bladder drainage. The use of FK506 might reduce the number of acute rejection episodes with no diabetogenic side effects. More studies have been presented which demonstrate that pancreas transplantation might improve diabetic microangiopathy and polyneuropathy and protect the transplanted kidney from diabetic nephropathy.