European Trial of Immunosuppression in SPK Tx

Inclusion Criteria: 1. Male or female patients, of 18 to 55 years of age, with end-stage, C-peptide-negative, Type 1-diabetic nephropathy. 2. Female patients of childbearing age must have a negative pregnancy test and must agree to maintain effective birth control practice throughout the study period (3 years). 3. Patient must have signed the Patient Informed Consent Form. 4. Patient must receive a primary simultaneous pancreas/kidney (SPK) cadaveric transplant, with either intestinal or bladder and either portal or systemic venous drainages. Exclusion Criteria: 1. Patient is pregnant or breastfeeding. 2. Patient is allergic or intolerant to Mycophenolate Mofetil, Sirolimus, Tacrolimus or other macrolides, or any compounds structurally related to these compounds. 3. Patient has a positive T-cell crossmatch on the most recent serum specimen. 4. Patient is known for active liver disease or has significant liver disease, defined by ASAT and ALAT serum levels greater than 3 times the upper limit of normal. 5. Patient has malignancy or history of malignancy, with the exception of adequately treated localised squamous cell or basal cell carcinoma, without recurrence. 6. Patient has been included in another clinical trial protocol for any investigational drug within 4 weeks prior to randomisation. 7. Patient has any form of substance abuse, psychiatric disorder or condition, which, in the opinion of the investigator, may invalidate communication. 8. Patient receives a SPK transplant from a living donor, or receives segmental pancreatic transplant, or a previous kidney transplant alone. 9. Pancreatic duct occlusion technique . 10. Donor is older than 55 years of age. \-