The morbidity and mortality associated with long-term diabetic complications continue to rise and will remain a major worldwide health problem in the coming years. Islet cell transplantation has recently emerged as one the most promising therapeutic approaches to improving glycometabolic control in diabetic patients and, in many cases, to obtaining insulin independence. Unfortunately, many flaws still persist that make it impossible for islet transplantation to become the gold standard treatment for type 1 diabetic patients. Investigators are still debating whether islet transplantation should be considered an option limited to specific single cases. We review the state of the art of islet transplantation, the outcomes, the immunosuppression, and most important the impact on patients survival and long-term diabetic complications and eventual alternative options. Finally, we review the many problems surrounding the field and the obstacles that islets face after transplantation. Islet cell transplantation requires a relatively short hospital stay and has the advantage of being a relatively noninvasive procedure. The rate of insulin independence 1 year after islet cell transplantation has significantly improved in recent years (60% at 1 year post-transplantation compared with 15% in past years). Recent data indicate that restoration of insulin secretion after islet cell transplantation is associated with an improvement in quality of life, with a reduction in hypoglycemic episodes and potentially with a reduction in long-term diabetic complications. Once clinical islet transplantation has been successfully established, this treatment could even be offered to diabetic patients long before the onset of diabetic complications.