Pancreas transplantation is the only long-lasting curative option patients with type 1 diabetes mellitus. During the last 50 years, it has evolved from an experimental procedure to an accepted... Show morePancreas transplantation is the only long-lasting curative option patients with type 1 diabetes mellitus. During the last 50 years, it has evolved from an experimental procedure to an accepted treatment. For patients suffering from diabetes mellitus induced end-stage renal disease, a simultaneous pancreas-kidney transplantation is the best option. Due to increased experience, the indications for transplantation have been expanded, causing waiting lists to increase. To match the increasing demand, transplant professionals are forced to accept higher risk donor organs. This thesis investigates those risks and aims to quantify the risk in donor risk indices. Those risk indices were also investigated in this thesis. Furthermore, solitary risk factors for outcome were investigated. There appears to be a significant association between center volume and outcome: high volume center have better results than low volume centers, despite accepting higher risk donor organs. Another risk factor that was investigated was donation after circulatory death (DCD) pancreas transplantation. It showed that DCD pancreas transplantation is a feasible option to expand the donor pool. Show less