Although pancreas transplantation in man is experimental and is carried out infrequently, lessons learned in this surgical event are applicable to more common abdominal procedures. Avoidance of pancreatitis in the graft, prevention of blowout of duodenal closure, and preservation of graft arterialization and venous outflow are of paramount importance. Physiologic principles learned in gastric, intestinal, and vascular surgery are utilized to achieve these objectives. A case report identifies the type of patient who is a candidate for pancreaticoduodenal and kidney grafting, and arteriographic and gastrointestinal contrast studies demonstrate the physiologic principles involved in the operation.