Pancreas transplantation has evolved within two decades from a poorly accepted therapeutic option to a highly successful procedure in the treatment of type 1 diabetes mellitus. Combined Pancreas-kidney transplantation is usually performed, but the value of pancreas after kidney transplant recently increased dramatically. Novel surgical techniques together with very effective immunosuppression (e.g. Prograf) and CellCept) and better postoperative management offer excellent long-term graft and patient survival with full insulin independence. Pancreas transplantation (alone or simultaneous with kidney) is highly cost-effective compared to any conservative alternatives.