Pancreas transplantation (PTx) is the treatment of choice for selected patients with type 1 diabetes mellitus. We reviewed our first 40 patients who underwent PTx in Shiraz organ transplant center. Between April 2006 and April 2008, we performed PTx on 40 recipients. The operation included portal venous drainage and exocrine enteric drainage. Immunosuppressive therapy included prednisolone, tacrolimus, and mycophenolate mofetil. Ganciclovir was administered as prophylaxis for cytomegalovirus. The mean follow up was 10.06 ± 6.46 months (range, 1-24). Mean age of donors and recipients were 23.57 ± 8.20 and 32.33 ± 8.86 years, respectively. Mean pre-transplant insulin consumption was 43.75 ± 17.40 IU. Fasting blood glucose before transplantation was 275.47 ± 72.33 mg/dl that decreased to 95.60 ± 7.97at 6 months follow-up (P=0.000). Complications were as follows: re-exploration (n=9), gastrointestinal complications (n=10), acute rejection episodes (n=12), chronic rejection (n=4). We had only one mortality case due to diffuse CMV and aspergillus infection 3 months after the operation with functioning graft. In conclusion, Good patient and graft survival in these series encouraged us to continue the program with all its difficulties.