Pancreas transplantation has emerged as an effective treatment for patients with long-standing type 1 diabetes mellitus resulting in an insulin-independent euglycemic state and normalization of glyco-sylated hemoglobin levels. In most cases, pancreas transplantation is performed at the same time as kidney transplantation from the same donor as simultaneous pancreas-kidney transplantation in patients with coexisting end-stage diabetic nephropathy, less frequently as sequential pancreas-after-kidney transplantation or pancreas transplantation alone. Various transplantation procedures exist, including transplantation of a whole pancreatic graft with a duodenal segment and enteric exocrine drainage via a duodenojejunostomy and systemic venous endocrine drainage via vascular anastomoses to the iliac vessels. In all modifications of pancreas transplantation, the recipients own pancreas is left untouched.