normally of ciclosporin, azathioprine and corticosteroids. But as episodes of rejection may reoccur throughout a patient's life, the exact choices and dosages of immunosuppressants may have to be modified over time. Sometimes tacrolimus is given instead of ciclosporin and mycophenolate mofetil instead of azathioprine. Types There are four main types of pancreas transplantation: Pancreas transplant alone, for the patient with type 1 diabetes who usually has severe, frequent hypoglycemia, but adequate kidney function. This pancreas transplant known as PTA has as of recently been showing up with good results. This is the least performed method of pancreas transplantation and requires that only the pancreas of a donor is given to the recipient. Simultaneous pancreas-kidney transplant (SPK), when the pancreas and kidney are transplanted simultaneously from the same deceased donor. This is the most commonly performed pancreas transplant operation. Indications for an SPK are End Stage Renal Disease with type 1 diabetes (with other diabetic complications like neuropathy, gastroparesis etc.) This is the most common type of pancreas transplantation. The basic reason for this is that patients are mostly already on immunosuppressive drugs and the addition of the kidneys simultaneously reduces the risk in surgical procedure. Pancreas-after-kidney transplant (PAK), when a cadaveric, or deceased, donor pancreas transplant is performed after a previous, and different, living or deceased donor kidney transplant. This method is usually recommended for diabetic patients after having a successful kidney transplant. The downside of this procedure is that patients are required to go through surgical risk twice. Simultaneous deceased donor pancreas and live donor kidney (SPLK) has the benefit of lower rate of delayed graft function than SPK and significantly reduced waiting times, resulting in improved outcomes. Preservation until implantation Standard practice is to replace the donor's blood in the pancreatic tissue with an ice-cold organ storage in the solution, such as UW (Viaspan) or HTK until the allograft pancreatic tissue is implanted. Prognosis The prognosis after pancreas transplantation is very good. Over the recent years, long-term success has improved and risks have decreased. One year after transplantation more than 95% of all patients are still alive and 80–85% of all pancreases are still functional. After transplantation patients need lifelong immunosuppression. Immunosuppression increases the risk for a number of different kinds of infection and cancer. It is unclear if steroids, which are often used as immunosuppressant, can be replaced with something else. History As described by a pioneer