Islet cell transplantation is on the forefront of innovative methods available to treat patients with type 1 DM. After nearly 3 decades of advances in both islet cell processing and immunosuppression techniques, we are beginning to see the clinical applications of this technique in selected patient groups. Although pancreas transplants have had a profound impact of the lives of thousands of patients, islet cell transplantation will offer the same advantages with reduced surgical morbidity cost. Over time, the procedural and immunosuppressive risks will diminish, and continued advances in isolation and engraftment techniques will render patients insulin-independent with the infusion of a small islet mass. Continued research in identifying the most appropriate donor and recipient population and optimal timing of the transplant will continue to help make islet transplantation a viable and dependable option for patients with type 1 diabetes. Much like pancreas transplants created and built momentum for the development of allo-islet transplantation, the increasing success of allo-islet transplants will build the momentum needed for islet xenotransplants and stem cell-derived islet cell transplants to be developed into a more widely available islet replacement therapy.