**8.1. Immunosuppression**

Advances in immunosuppression protocols during the last two decades significantely increased short- and long-term pancreas graft survival. The purpose of immunosuppression is control alloimmune response, and protocols often include a combination of different drugs to minimize the damage to the graft and the risks to the patient. They are similar in all solid organ transplants. Nonetheless, it is of particular relevance in pancreas transplant recipients due to the increased risk of acute rejection, especially in recipients of pancreas transplant alone (PTA). The greatest burden of immunosuppression is then usually administered in the recipients of a PTA.

Immunosuppression is usually dived into two major categories—induction and maintenance. The former represents treatments used in the peri-transplant period alone, with the objective of inhibiting both the innate and adaptative immune response when the graft is first exposed to recipient immune system. The drugs used are the same as for other solid organ transplantations and have been described in other chapters. The next section describes how and what drugs are used in pancreas transplantation:
