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The field of clinical islet transplantation has seen a recent crescendo of interest. This review will describe the current state of islet transplantation, with particular emphasis on its use in the treatment of type 1 diabetes, and provide insight into the barriers preventing widespread clinical application.Islet transplantation is considered a promising potential therapy for patients with type 1 diabetes mellitus. It offers an attractive alternative to exogenous insulin with potentially fewer complications and a larger supply of donor material than is available for solid organ pancreas transplant. Since the 2000 announcement of 100% insulin independence in seven patients from the center in Edmonton, high rates of initial insulin independence have been achieved at other centers. There have been improvements in donor selection and islet processing, expanding potential applications. Longer-term follow-up studies showing the duration of insulin independence, graft function, and effects on diabetic complications are now being reported.Although clinical islet transplantation remains limited to research trials, more centers are demonstrating high rates of initial insulin independence. Glycemic control, beta cell reserve, and longer-term insulin independence appears inferior to that seen with whole-pancreas transplant. Even in insulin-dependent recipients, however, preliminary data show beneficial effects on both acute and long-term diabetes complications as long as appreciable C-peptide is detectable from the grafts.