Background: Simultaneous kidney and pancreas transplantation (SKPT) is the treatment of choice for patients with type 1 diabetes mellitus and end-stage renal disease. A successful transplantation result in improved functional status, health-related quality of life and reproductive health. The most significant factors for successful outcomes for mother and child are stable pre-pregnancy transplant function tests and absence of immunosuppressive therapy. Pregnancy after transplantation is a high-risk condition; it should be carefully considered, planned, and monitored by a multidisciplinary health care team. Case presentation: We describe a case report of a 40 years old woman, how had two successful pregnancies after a simultaneous kidney and pancreas transplantation. Her pregnancy course was uneventful until 34 weeks of gestation when she had pre-eclampsia in the first pregnancy and PPROM in the second pregnancy. Conclusion: Scientific data about simultaneous kidney and pancreas transplantation are yet limited, so it is difficult to build guidelines in this clinical condition. We describe in literature the first case of two successful pregnancy after SKPT. Both babies had a low birth weight in coincidence with lower gestational age and in the first pregnancy, the mother developed preeclampsia.