Objective To report the modified technique and the short-term results of simultaneous pancreaticoduodenum-kidney transplantation (SPK) with the enteric drainage (ED) of exocrine secretions. Method Between June 2000 and Jan 2006, thirty-five patients with diabetes and uremia underwent SPK. The pancreas graft is placed intraperitoneally with its exocrine secretions drained into the proximal jejunum without Roux-en-Y procedure. The mean cold ischemic times of kidney was 6. 92?2. 17 hours and that of pancreas, 9. 65?2. 02 hours. Quadruple immunosuppressive therapy with antilymphocyte globulin or antiCD25 monoclonal antibody ( Zenapax ) , tacrolimus, mycophenolate mofetil and steroids was adopted. Results Postoperative patient and graft survival rates were 97. 3%. All patients achieved insulin-free euglycemia at 8.3?4.5 days postoperatively. Preoperative patient's mean fasting insulin and C-peptide values were 7.45?7. 35 mU/L and 5. 68?4. 66 mU/L. After operation, patients had fasting insulin and C-peptide values of 11. 9?5.70 mU/L and 5. 57?4. 90 mU/L, respectively, which peaked to an insulin level of 57. 9?46.6 mU/L and a C-peptide level of 11.75?6.99 mU/L with stimulation. The pancreas grafts also functioned well as evidenced also by normal serum amylase values of 92. 10?12. 24 U/L on 10th postoperative day. There were five cases of delayed renal graft function. All other patients achieved immediate renal graft function. No graft losses occurred due to leakage or intra-abdominal infection. The most commn surgical complications were wound infection (n - 11) , enteric anastomostic hemorrage ( n = 5) , and peri-renal hemorrage (n =2). Conclusions SPK is a effective treatment option for patients with diabetes mellitus and uremia. Enteric exocrine drainage by direct side-to-side anastomosis (without Roux-en-Y loop) seems to be a simple and reliable technique.