The International Pancreas Transplant Registry (IPTR) was founded in 1980. In the beginning it collected information for pancreas and islet transplants but split in 1989 into the IPTR and the ‘International Islet Transplant Registry (ITR). Despite the split, the members of the IPTR are actively involved in the Collaborative Islet Transplant Registry (CITR) to promote its mission. This is especially important since physicians treating diabetic patients still underestimate the beneficial effect of ß-cell replacement therapy. The IPTR has collected core information on over 50,000 pancreas transplants done worldwide; performed analyses on outcomes according to multiple variables; and communicated the information by publications and presentations at scientific meetings, making it freely available to the health care community as well as the general public to advance the field of ß-cell replacement therapy for diabetes mellitus. To minimize transplant center effort, maximize data completeness, and work effectively, the IPTR cooperates with other registries such as the United Network for Organ Sharing (UNOS) and Eurotransplant. These core data from all centers is supported by more comprehensive information from the University of Minnesota’s and University of Arizona's multi-organ databases. We collect in-depth information about pre-transplant comorbidity, surgical techniques, donor pancreas quality, post-transplant complications, immunosuppressive protocols, and long-term follow-up. This enables us to do more comprehensive multivariate analyses for pancreas as well as for islet transplants. Over the last decade we saw a substantial improvement in the short- and long-term outcome of pancreas transplants. We estimated that the risk-adjusted half-life of patients which received a simultaneous pancreas/kidney transplant in 1998/99 reached 148 months. Patients which received a solitary pancreas transplant are estimated to have a half-life of 74-79 month. The success can be attributed to the refinement in surgical technique, better less diabetogenic immunosuppressive drugs, and better pre- and post-operative prophylaxes. Since especially the long-term outcome of solitary pancreas transplants needs improvement more strategies and better immunosuppressive protocols have to be developed to reach this goal. Pancreas transplantation is an invasive procedure with the risk of surgery. Islet transplantation in contrast contains a much lower risk. We plan to translate the lessons we learnt to improve pancreas transplantation into islet transplantation. Models have to be refined to find the best kind of ß-cell replacement therapy for a patient with a specific comorbidity profile. Important impact factors on outcome are the status of secondary diabetic complications of a potential recipient. There are also criteria to be developed for the allocation of a deceased donor pancreas. At the moment mostly older overweight donor pancreata are used for islet transplantation, while the better quality donors are used for whole organ transplants. More comprehensive models have to be developed to show the impact of those donor factors on the outcome of pancreas and islet transplants. Answering such questions will allow us to improve the outcomes of pancreas transplants and also gain important information for the advancement of islet transplants.