Abstract
This chapter consists of two sections, the original version in the first edition of Pancreas Transplantation, and now an update, 20 years later. The original version highlighted the experimental models of transplantation tolerance, mostly murine, that led to clinical trials in kidney transplantation (KT). These clinical trials included the use of donor bone marrow with or without the development of chimerism. The update follows the results of the two living donor KT tolerance trials described previously in the first chapter initiated at the Massachusetts General Hospital and Stanford, and the more recently started trials at Northwestern University. All three trials show promise, although they do not allow broad clinical applicability, rather the potential for confirmation in larger trials. Other possible approaches include the use of regulatory cells (T regs, B regs, regulatory macrophages or dendritic cells) and the possibility of regenerative medicine applications. The successful development of tolerance for KT recipients using any of these approaches could conceivably lead to use in pancreas transplantation.