Background Pancreas transplants were performed successfully in 1961 at the University of Minnesota. The first pancreas transplant in Australia was performed in Monash National Pancreas transplant unit (NPTU). Currently Monash national pancreatic transplant center performs a third of Australia’s pancreas transplants. Methods Retrospective analysis of all pancreatic transplants done from 1984 to 2022. All types of pancreatic transplants will be included (Simultaneous pancreas and kidney transplants (SPK), Pancreas after kidney (PAK), Pancreas transplants alone (PTA)) Surgical technique, Portal or systemic, exocrine drainage were also collected for the study. Outcomes that were collected include graft associated complications such as graft thrombosis rate and ultimately, pancreas graft survival rate and length of Stay. Results 48 pancreatic transplants were done from 1984 to 2001, following that from 2002 to 2022 that number increased to 236 transplants in total. Surgical technique including pancreatic drainage have evolved from Bladder to enteric drainage. Venous drainage on the other hand have evolved from systemic to portal and currently back to systemic drainage. The rate of Early pancreatic allograft thrombosis (EPAT) in the institution was 20%(CIV), 23%(EIV) and 14%(SMV) from 1984-2001 and subsequently reduced to 5.9%(IVC), 23.3%(CIV), 26.1%(EIV), 13.3% (SMV) after altering the surgical technique. Finally, pancreatic graft survival rates were 75.05% 1-year graft survival and 55.55 5-year graft survival from 1984 to 2001 and 93.5% 1-year graft survival and 80.6% 5-year graft survival from 2002-2022. Conclusion Pancreatic transplants are medically complex and technically demanding procedures that should be done within a specialized unit.