“…Current 10-year pancreas graft survival rates are 68% in simultaneous pancreas kidney transplantation (SPK), 46% in pancreas after kidney transplantation (PAK), and 39% in pancreas transplantation alone (PTA) [ ], studies reporting histological findings in pancreas transplantation are scarce and progress in the development of diagnostic guidelines has been slow [6][7][8][9][10]. Pancreas allograft function is clinically most often monitored by hyperglycemia, serum amylase, serum lipase, or (when bladderdrained) amylasuria [10]. These clinical tools are not accurate, and a diagnosis of acute rejection can only be established with certainty by tissue evaluation enabling the distinction between nonimmune and immune injury to the graft, and T-cellmediated versus antibody-mediated injury, guiding appropriate therapy decisions [6,7,11].…”