A new study reports that simultaneous pancreas–kidney transplantation effectively reverses the microvascular structural abnormalities of patients with diabetic nephropathy within 1 year of transplantation. Using sidestream dark field imaging, Khairoun et al. found that capillary tortuosity was increased in transplant naive patients with type 1 diabetic nephropathy but reversed by simultaneous pancreas–kidney transplantation. By contrast, capillary tortuosity in kidney transplant recipients was not different to that of untransplanted patients. The ratio of circulating angiopoietin-2 to angiopoietin-1 was also decreased after simultaneous organ transplantation.