Introduction After loss of a primary transplanted pancreas allograft, retransplant alone can return patients to an insulin-free life. This systematic review aims to explore the history of, discuss the technical surgical considerations and report the patient and graft survival outcomes of pancreas retransplant (PRTx). Methods A systematic review of the literature (EMBASE, MEDLINE and SCOPUS) was undertaken according to PRISMA guidelines. The primary outcomes of interest in this study were overall patient and graft survival at one and five years post PRTx. Secondary outcomes of interest included the surgical techniques used to implant the PRTx grafts, in particular the optimal method used for managing the exocrine duct and venous drainage of the allograft. Results Fifteen studies were eligible for inclusion encompassing 975 PRTx. Patient survival post PRTx was 90.2% at 1yr and 82% at 5 yrs. PRTx graft survival was 68.4% at 1yr and 55.9% at 5 yrs. Simultaneous pancreas kidney transplant was associated with better PRTx graft survival in several studies, compared with pancreas retransplant alone or pancreas after kidney retransplant. We found that bladder drainage of the PRTx graft may be associated with a reduced likelihood of technical failure and improved death-censored graft survival at five years, but this outcome of interest was inadequately reported across included studies. Conclusions We have demonstrated that PRTx is a safe and acceptable procedure for carefully selected patients with diabetes mellitus who lose their initial graft. Moving forward, research is needed to determine the impact of exocrine drainage techniques on graft and patient survival; ideally via prospectively designed studies.