Multiple allograft duplex sonographic examinations were performed on six patients who underwent pancreas transplantation to determine the role of this imaging modality. Poor correlation was found between gland size, parenchymal echogenicity or resistive index, and either rejection and/or cyclosporine toxicity. The pancreatic duct was not dilated on any of the examinations. Seven peripancreatic fluid collections were noted but were generally small. In one patient, no Doppler frequency shifts were found in spite of extensive interrogation of the parenchyma and subsequent biopsy confirmed allograft infarction. Duplex sonography appears most useful for excluding ductal dilatation, for detecting peripancreatic fluid collections, and for identifying infarction. © 1991, J.B. Lippincott Company. All rights reserved.