 Whole organ pancreas and islet transplants are two potential treatments for type 1 diabetics who are resistant to optimized medical care. Factors such as kidney function, comorbidities, and treatment goals should be considered when selecting the best option for beta cell replacement. In cases of end-stage kidney disease, simultaneous pancreas kidney transplantation, SPK, is typically recommended. However, due to its complexity and risk, it is important to select candidates carefully. New strategies such as dynamic organ perfusion technology, pancreas bioengineering, and stem cell therapy have been developed to improve outcomes and reduce immune rejection. Overall, SPK has shown promising results in terms of long-term survival and quality of life, but further research is needed to optimize outcomes and reduce risks associated with the procedure. This article was authored by David Martin, Piero Alberti, Nicholas de Martens, and others. We are article.tv, links in the description below.