Introduction: Worldwide, the prevalence of people living with diabetes mellitus is rapidly exploding. This is not only true for type 2 diabetes but also for type 1.  Pancreas transplantation evolved significantly over the last decades and is now the best method to manage patients with poorly controlled diabetes, hypoglycemic unawareness, brittle diabetes and/or end-stage kidney disease. This study shows the worldwide development in pancreas transplantation.
Methods: Since the first pancreas transplant in 1966, the International Pancreas Transplant Registry  collected information about this procedure from all over the world and up-to this date Information of almost 70,000 pancreas transplants were performed.  This study concentrates on the development over the last 10 years.
Results: While the numbers of pancreas transplants declined in the US after 2004, the numbers steadily increased outside the US. After 2008, more pancreas transplants were performed outside the US. While the numbers in North America stabilized, transplant  numbers significantly decreased in Europe (Table 1).

In contrast, pancreas transplantation increased in South America, Oceania, Middle East, and East Asia dramatically. By far the most procedures were performed with a combined kidney transplant. Figure 1 shows the worldwide number of pancreas transplants in relationship to countries population size for 2021.

Finland and the Czech Republic are the leading countries followed by the USA.  Of note, India and China had also started with very successful pancreas transplant programs.
Covid-19 had a detrimental effect on the further growth of pancreas transplantation and many countries saw a sharp decrease in yearly transplant numbers. In 2020, only Austria, Colombia, Hungary, Denmark, and Switzerland which performed relatively few transplants and Australia which has a thriving transplant program showed an increase in transplants  from 2019. In 2021, an increase in pancreas transplant numbers could be detected but was still lower compared to 2019 in most countries. Some countries reported still a decline in numbers  of around 50%.
The decline in transplant numbers was noted especially in solitary transplants. Most pancreas transplants were performed in combination with a kidney. While in Western countries most patients were registered as having  type 1  , the indication in Eastern countries was more often type 2 diabetes. For countries who reported transplant numbers for 2022, a recovery and increase in numbers could be seen.
Conclusion: With the improvements in pancreas transplantation over time, this procedure has achieved more acceptance worldwide in patient with type 1 as well as type 2 diabetes mellitus and improves life-expectancy and quality of life.