Pancreas transplantation represents a solid approach to restore long-term normoglycemia in diabetic patients by replenishment of β-cell functional mass. At the end of 2023, in our center 436 pancreas transplants have been performed. Of them, 25% were pancreas transplant alone (PTA). To date, the long-term safety and efficacy of PTA are still debated. In the present study, we report the outcomes of PTA as performed in our center after 20-year actual follow-up. Thirty-nine consecutive patients were studied (re-transplants excluded), having the following clinical characteristics at time of transplant: age: 38±8.5 yrs; 20 males and 19 females; BMI: 23.9±3.1 kg/m2; duration of T1D: 25±10.4 yrs; C-peptide values: 0.1±0.2 ng/ml; insulin requirement: 45±11.8 IU/day; eGFR 104.7±37.6 ml/min/1.73m2. PTA was performed with portal-enteric drainage. The anti-rejection induction therapy included high dose steroids and either basiliximab or anti-thymocyte globulin (in 92.3% and 7.7% of cases, respectively). Tacrolimus, mycophenolate and low-dose prednisone were used in the maintenance phase. At the end of follow-up, patient survival was 74% (29/39 patients). Based on internationally accepted criteria, pancreas graft function (death censored) was excellent or good respectively in 19 (49%) and 3 (8%) patients. In the former, HbA1c was 5.8±0.7% and C-peptide was 2.8±1.6 ng/ml. During the follow-up, 8 patients developed end stage renal disease (ESRD). Of them, 5 subjects were on dialysis and 3 had received a kidney transplantation. In 3 of these patients, eGFR before PTA was <60 ml/min/1.73m2. The average time from PTA to the onset of ESRD was 15±4.8 yrs. The other PTA patients showed an eGFR of 73.9±25.5 ml/min/1.73m2. These actual 20-yr results show that PTA is an effective and reasonably safe option to cure diabetes long-term in selected cases of T1D patients.