Transactions allow database operations to be executed reliably and in isolation. The ACID properties - Atomicity, Consistency, Isolation, and Durability - guarantee that transactions are processed reliably. Isolation levels like Read Committed and Repeatable Read protect against dirty reads and non-repeatable reads. The highest isolation level, Serializable, prevents serialization anomalies. Proper use of locks and managing deadlocks are important to ensure transactions complete reliably. Optimistic locking provides an alternative locking approach to avoid lock contention.