Pancreas transplantation is the more effective cure for type 1 diabetes. Although intensive insulin scheme has been demonstrated to reduce the incidence of diabetes related complication, only pancreas transplantation normalizes glycometabolic control, avoids the risk of severe hypoglycemic events and prevents or in some case ameliorates diabetes related complications. In this review it will be analyzed the impact of pancreas transplantation on diabetes related complication and patient survival. Islet cell transplantation has recently emerged as one the most promising therapeutic approaches to improving glycometabolic control in type 1 diabetic patients and, in many cases, to obtaining insulin independence. Islet cell transplantation requires a relatively short hospital stay and has the advantage of being a relatively noninvasive procedure. The rate of insulin independence 1 year after islet cell transplantation has significantly improved in recent years Data from a recent international Trial confirmed that islet cell transplantation can be potentially a cure for type 1 diabetes. Recent data indicate that insulin independence after islet cell transplantation is associated with an improvement in glucose metabolism and quality of life and with a reduction in hypoglycemic episodes. Islet cell transplantation is still in its initial stages, and many obstacles still need to be overcome. Once clinical islet transplantation has been successfully established, this treatment could even be offered to diabetic patients long before the onset of diabetic complications or to patients with life-threatening hypoglycemic unawareness and brittle diabetes.