The possibility of an immunological follow-up of the pancreas through the renal transplant after simultaneous pancreaticorenal transplantation (S.P.R.T.) is controversial. Fifty patients have received a neopren-injected extraperitoneal segmental pancreatic transplant and a contralateral renal transplant, after immunological preparation with blood transfusions, without tissue matching but with a negative anti-T lymphocyte cross-match. Immunosuppression consisted in a three- or four-drug therapy during the first 10 days, then a long-term two-drug therapy (ciclosporine and azathioprine). Sixteen rejection episodes were noted in 16 patients during the first 3 postoperative months. No concomitant alteration of the pancreatic function occurred (no pancreatic histology). No isolated pancreatic rejection has been noted so far. One patients presented with 2 episodes of simultaneous rejection 15 and 26 months after transplantation. The actuarial survival rate at 2 years of the patients, kidneys and pancreata respectively is 96%, 92% and 80%. The absence of long-term alteration of the pancreatic function probably proves the absence of undetected pancreatic rejection. In our experience, the follow-up of the renal function allows screening and treating rejection episodes before a possible functional alteration of the pancreatic transplant occurs. In our opinion, extraperitoneal segmental pancreatic transplantation, a simple procedure with satisfactory metabolic results in the long term, is a good technique for S.P.R.T.