Today, combined kidney and pancreas transplantation is the best treatment for patients with type I diabetes and pre-end or end-stage renal disease due to the diabetic nephropathy. Twenty-nine patients underwent that procedure at our Institution. Recent technical modifications--with the use of a whole pancreas graft with urinary drainage of the exocrine secretion in the recipient by performing a pancreatico-duodeno-cystostomy--allow the monitoring of the exocrine secretion which is a pertinent immunological marker for pancreas rejection. In the next future, pancreas alone should be considered safely using the same procedure, in non uremic diabetic recipients in whom extra-renal secondary complications are more serious than the potential side effects of chronic immunosuppression. That type of pancreas transplantation should benefit of the forthcoming immunosuppressive drugs.