Normoglycemia is the treatment goal for patients with diabetes mellitus. Currently, pancreas transplantation can offer this ideal, but at the cost of lifelong immuno suppression and the accompanying side effects of anti rejection drugs. Pancreas transplantation alone is per formed in some cases but is typically offered in combination with kidney transplantation. The authors review several issues concerning kidney-pancreas trans plantation and anesthetic management. Patient selec tion, donor selection, surgical technique, immunosup pression, antimicrobial prophylaxis and surgical complications are discussed. Anesthetic preoperative evaluation includes special attention to the diabetic patient's airway and the risk of aspiration, as well as cardiovascular and neurologic compromise common in this patient population. Preoperative, intraoperative and postoperative anesthetic management focuses on the disease process as well as the procedure.