Islet After Kidney Transplantation (IAK) in Patients With Type 1 Diabetes

Inclusion Criteria: * Type 1 diabetes mellitus. Documentation of negative basal and stimulated C-peptide (a basal level of \</= 0.2 ng/ml before IV administration of 1 mg of glucagon, and a glucagon stimulated C-peptide \</= 0.8 ng/ml) and diagnosis of diabetes for at least 5 years. * Recipient of renal transplant with good function (serum creatinine \</= 1.6 mg/dl, creatinine clearance \>/=60 ml/min and albumin excretion \</= 300 mg/24 hr) for \>3 months. * Stable immunosuppression consisting of any combination of sirolimus, tacrolimus, MMF or \</= 5 mg/day of corticosteroids for at least 3 months, without major complications. * No history of acute rejection episodes related to renal graft in last 12 months and low risk for developing acute rejection (first renal transplant, PRA \<25%, negative kidney crossmatch by B, T, flow cytometry) * Under the continuing care of a renal transplant nephrologist/surgeon. * No evidence of liver disease (liver enzymes \< twice the upper limit of normal for each of ALT and AST, bilirubin \< 2 mg/dl, albumin \> 3.5 g/dl, and PT and PTT \</= 1.1 x the upper limit of normal). * Ability to comply with post-transplant regimen, including immunosuppression, insulin pump therapy and metabolic testing. Patients will be required to perform self-monitoring of blood glucose a minimum of four times daily, and provide complete records of blood glucose levels and insulin doses. * Ability to give informed consent. * Age greater than or equal to 18 years or…