The results of pancreas transplantation have improved markedly over the last decade, owing equally to improvement in proper patient selection, organ preservation, refinements in surgical technique, early diagnosis and treatment of rejection, and management of potential complications. Among all pancreas transplants reported to the International Pancreas Transplant Registry, simultaneous transplantation of the pancreas and kidney with bladder drainage is the technique associated with the best graft survival rates. Graft and patient 5-year survival rates of 80 and 86%, respectively, can be achieved and are now comparable to those of other organ transplants. Objective improvement in diabetic neuropathy, vasculopathy, and retinopathy, as well as in prevention of recurrent diabetic nephropathy, has now been demonstrated. Simultaneous pancreas-kidney transplantation is now considered the procedure of choice for selected uremic diabetic patients.