Islet transplantation consisted of up to three sequential fresh islet infusions within 3 months, with the aim of reaching adequate metabolic control without exogenous insulin. Islets were isolated from ABO-compatible deceased donor pancreata with a negative cross-match and evaluated as previously described (8 (link)). The access to the portal vein was gained under general anesthesia by percutaneous catheterization of a peripheral portal branch under ultrasound guidance or by surgical catheterization of a small mesenteric vein. In all cases, heparin (35 units/kg) was added to the final product, gently infused by gravity with portal pressure monitoring. Immunosupression consisted of tacrolimus (Prograf) (Astellas, Fujisawa, Japan), target trough levels at 3–6 ng/ml, and sirolimus (Rapamune) (Wyeth Pharmaceuticals France, Paris, France), target trough levels at 12–15 ng/ml for 3 months and at 7–10 ng/ml thereafter. A five-dose induction course of dacluzimab (Zenapax) (1 mg/kg) (Roche, Welwyn Garden City, U.K.) was administered biweekly beginning 1 h before the first infusion.