Replacement of beta-cell function by transplantation of endocrine tissue is an alternative treatment for patients with complicated type 1 diabetes. Pancreas transplantation is presently the only treatment allowing to normalise glycemia without increasing the risk of hypoglycemia and to stop exogenous insulin-therapy. In spite of postoperative morbidity and mortality, pancreas transplantation improves quality of life, reduces cardiovascular risk factors and prolongs the life expectancy of diabetic patients with end-stage kidney failure. Islet transplantation is still an experimental procedure. However, the results obtained recently are a proof of principle that a cellular transplant can induce normoglycemia and insulin-independence in diabetic patients. In this review, the results and perspectives of pancreas and islet transplantation are discussed.