Diabetic nephropathy affects 20-35% patients with diabetes mellitus. After 25-30 years of nephropathy, chronic renal failure (CRF) develops in these patients. The aim of the study is to present the influence of simultaneous pancreas and kidney transplantation (SPK) on long-term diabetic complications in patients with CRF in course of insulin dependent diabetes mellitus and the length and quality of life of these patients. SPK has positive influence on nerves function of peripheral and autonomic nerve system, as well as heart ventricle function, but brings only limited benefits as regards progression of diabetic retinopathy and nephropathy. The life time of the patients in which SPK was performed is significantly longer that in dialysed patients treated with insulin and patients, in which only cadaveric kidney transplantation was performed. In patients after SPK an improvement of quality of life is also observed. SPK should be considered at the moment of appearance of renal failure symptoms in patients with long lasting insulin dependent diabetes mellitus. Proceeding like this may significantly improve prognosis in this patients, outstandingly disadvantageous if only intermittent dialysis is applied.