A successful pancreas transplant produces a normoglycemic and insulin-independent state virtually immediately after revascularization. There are important considerations of pancreas transplantation that currently precludes it as therapy for all patients with type 1 diabetes mellitus (DM1). Vascular thrombosis is a very early complication typically occurring within 48 hours. Transplant pancreatitis occurs to some degree in all patients. Bleeding from the vascular anastomotic site or cut surfaces of the pancreatic graft will result in an intra-abdominal hematoma. Peri-pancreatic infections can result in development of a mycotic aneurysm at the arterial anastomosis, which may rupture, and requires allograft pancreatectomy. The outcome of pancreas transplantation with respect to graft survival and rejection rates is dependent on the choice of immunosuppression agents used. The durability of the transplanted endocrine pancreas has been established with the demonstration that normalization of HbA1c is maintained for as long as the allograft functions.