ISLETS AFTER KIDNEY

Subject Inclusion Criteria

1. Type 1 insulin-dependent diabetes > 10 years
2. Prior successful kidney transplant
3. Not on steroid therapy for maintenance immunosuppression
4. No history of prolonged high dose steroid use within one year of transplantation
5. Patients who have failed intense insulin therapy under the guidance of an endocrinologist
6. Patient must have hypoglycemia unawareness with metabolic lability
7. Age > 18 < 65
8. C-peptide negative (< 0.5 ng/ml)
9. PRA < 20%
10. Patient is capable of understanding the purposes and risks of the study and of signing a statement of informed consent for each element of the study
11. Women who are of child bearing potential must have a negative serum pregnancy test prior to transplant

Subject Exclusion Criteria

1. Severe co-existing cardiac disease such as
   • Recent MI (within the past 6 months) or
   • Non-correctable coronary artery disease by angiogram
2. Duration of diabetes < 10 years
3. Age < 18 or > 65
4. PRA > 20%
5. Positive pregnancy test
6. Anemia; Hct < 25%
7. Severe insulin resistance, insulin requirements more than 0.7 U/kg
8. C-peptide response to arginine stimulation (5gm IV) > 0.3 ng/ml at 2, 3, 4, 5, 7 and 10 minutes)
9. Active infection, including hepatitis B, C, HIV or TB
10. Active peptic ulcer disease
11. History of or anticipated noncompliance
12. Active alcohol or substance abuse, includes cigarette smoking (must be abstinent for 6 months)
13. Obesity (i.e.: body mass index > 28)
14. Any history or current malignancies except for squamous or basal skin cancer
15. Hepatitis (chronic or active) or portal hypertension, abnormal liver function
16. Gallstones or hepatic hemangiomas
17. Allergy or sensitive to contrast agents
18. Enrolled in another, simultaneous investigational protocol other than islets after kidney
19. Hypercoagulative state or disorder requiring uninterrupted anticoagulation therapy
20. Use of coumadin or other anticoagulant therapy or subject with PT-INR > 1.5
21. Under treatment for a medical condition requiring chronic steroid use
22. Addison's Disease
23. HgbA1C > 12%
24. Hyperlipidemia (treated or untreated fasting LDL > 130 mg/dl, and / or fasting triglycerides > 200 mg/dl.)
25. Untreated proliferative retinopathy
26. Allergy to heparin