*Purpose: Pancreas Transplant (PTx) is an established treatment for patients with diabetes mellitus. Diagnosis of rejection has continued to be problematic. In 2007, a new technique of PTx with portal-endocrine and gastric exocrine (P-G) drainage was first performed at our institution. This technique facilitates access to pancreas allograft. Our objective is to report our experience with the first 89 patients who underwent PTx using P-G technique.

*Methods: The first 89 patients who underwent PTx since 2007 were studied. In these patients, arterial and venous anastomosis was similar to standard portal-enteric (P-E) technique, though contrary to other techniques of enteric drainage, the end of allograft jejunum was anastomosed to the anterior aspect of the stomach. Patients were followed as outpatients. Allograft dysfunction was studied with endoscopy via gastro-jejunostomy and treated accordingly.

*Results: Donor and recipient demographic data, number of antigens matches, and immunosuppressant were collected. All patients achieved euglycemia. 6 patients underwent pancreatectomy: 2 due to vessel thrombosis and 4 due to chronic rejection. 6 patients died – 5 with functioning pancreatic and renal allografts. 7 patients with CMV and 9 patients with rejection were diagnosed, of which one was treated. Patient and graft survival were 93% and 90% respectively.

*Conclusions: This technique of PTx has proven to be safe with good patient and allograft survival. Access to donor duodenum and pancreas allograft via endoscopy is unique to this technique and provides the added advantage of life-long easy access to allograft.

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