*Purpose: Islet transplantation (ITX) is an ideal treatment for type 1 diabetic patients. In this paper, we compared the outcome of ITX depending on Era in Japan.

*Methods: In Japan, the first ITX was introduced in 2004 and 34 ITX for 18 patients were performed until 2007 (Era 1, N=18). In Era 1, immunosuppression was achieved using modified Edmonton protocol. Thereafter, we have changed an immunosuppression protocol to Minnesota protocol (ATG+anti-TNFa) and 14 ITX for nine patients were, so far, performed (Era 2, N=8, multicenter Trial; CIT-J003). Although all donors were DCD donors in Era 1, DBD donors were used in 12 out of 14 ITX in Era 2.

*Results: In Era 1, most of all the patients showed the disappearance of hypoglycemic unawareness and decreased HbA1c levels. However, serum C-peptide levels(CPR) decreased year and year. Five year islet graft survival, which was defined as positive CPR(> 0.3ng/ml), 22.2% in all patients and 30% in the patients with repeated ITX. While, in Era 2, although the first 4 patients with low dose of CNI administration showed the similar results as Era1, the latter 4 patients with increased dose of CNI showed a positive CPR, normal HbA1c level (5.1- 6.6%), complete disappearance of hypoglycemic unawareness for more than two years. In addition, a glucagon stimulation test showed the positive stimulated CPR in all 4 patients, which indicated the good endocrine function of islet grafts. One patient has achieved an insulin independency after the second ITX.

*Conclusions: According to the use of DBD donors and introduction of newly designed immunosuppression protocol, the outcome of ITX has improved recently in our country. ITX is expected to be the promising treatment as the first choice for nonuremic type 1 diabetic patients.

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