The present study evaluated the outcome of a Sirolimus based maintenance immunosuppressive protocol in pancreas transplant recipients. Between August 2003 and December 2013, a total of 332 pancreas transplants were performed. There were 261 simultaneous pancreas/kidney recipients (SPK), 55 sequential pancreas recipients (after successful kidney transplant PAK), and 16 isolated pancreas recipients (PA). There were 211 males and 290 were Caucasians. The mean age of the recipients was 41.2±8.4 years. All recipients received Sirolimus based, steroid free maintenance immunosuppression. The immunosuppressive protocol consisted of induction with Thymoglobulin and prednisone for the first 5 days. Patients were maintained on Sirolimus (starting day 0) and Neoral (starting day 2-4 based on kidney function). Sirolimus dose was adjusted to a target rapamycin trough level and Neoral dose was adjusted to target C2 levels. Portal vein thrombosis requiring transplant pancreatectomy occurred in 12 patients (3.6%). Of these 12 patients with portal vein thrombosis, 10 patients were post SPK and two were post PAK. 66 patients (19.9%) developed biopsy proven acute rejection so far whereas 80.1% remained rejection free. One year biopsy proven acute rejection rate was 13.9%. One, three and five year patient survivals were 94.6%, 90.7% and 84.6%. One, three and five year pancreas survivals were 93.9%, 87.5%, and 82.8%. The corresponding figures for kidney graft survivals (SPK recipients only) were 96.2%, 88.8% and 81.7%. We conclude that excellent graft survival with a low incidence of acute rejection can be achieved using a Sirolimus based steroid free immunosuppression.

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