In vascularised pancreas transplantation the organ is transplanted as a whole (as opposed to islet cell transplantation, which is still experimental). The procedure re-establishes endogenous secretion of insulin that is responsive to normal feedback controls and is currently the only known treatment for diabetes that reliably achieves a euglycaemic state with complete normalisation of glycated haemoglobin concentrations.1 The costs that must be paid for normal glucose homeostasis are the operative risks of the procedure and the need for chronic immunosuppressive treatment. Between 1966 and 1995 over 7500 pancreas transplantations were performed worldwide and reported to the International Pancreas Transplant Registry.2 Most (87%) of these organs were transplanted in conjunction with kidneys as combined pancreatic and renal transplants into patients with impending or actual renal failure. The other operations included transplantation of the pancreas after the kidney (7.4%), pancreas transplantation done alone(5%), and pancreas transplantation in conjunction with a single organ other than the kidney or with multiple organs (less than 1%). The total number of pancreas transplantations done each …