A drawback in pancreatic islet transplantation is the large number of islets needed to obtain insulin independence in patients with diabetes. This most likely reflects extensive posttransplantation islet cell death and functional impairment of the remaining endocrine cells. We aimed to develop an experimental method to retrieve transplanted islets from the mouse liver, which would enable comparisons of transplanted and endogenous islets and provide valuable information on functional changes induced by intraportal transplantation. Transplanted islets were obtained by retrograde perfusion of the liver with collagenase. The identity of retrieved tissue as transplanted islets was confirmed by intravital staining, immunohistochemistry, and electron microscopy. The retrieved islets, irrespective of whether they had resided in diabetic or nondiabetic recipients, had a markedly lower insulin content and glucose-stimulated insulin release when compared with isolated endogenous islets. The glucose oxidation rate was also markedly lower in the retrieved islets, suggesting mitochondrial dysfunction. These disturbances in insulin content, insulin release, and glucose oxidation rate were not reversed by a few days of culture after retrieval. The results implicate changes in islet function after intraportal transplantation. Such dysfunction may contribute to the high number of islets needed for successful transplantation in diabetic individuals. Diabetes 53:948 -954, 2004 R ecent modifications in islet allotransplantation protocols, such as immunosuppressive treatment regimens without steroids and cyclosporine, as well as repeated transplantations to increase the implanted endocrine mass, have substantially increased the number of patients who achieve insulin independence (1-3). However, that two to three transplantations are usually needed to reverse hyperglycemia in humans suggests that the liver does not provide optimal conditions for engraftment. Indeed, although Ͼ85% of the normal islet mass (4) was transplanted when applying the Edmonton protocol, the insulin response to glucose in these patients was only ϳ20%, whereas the insulin response to arginine (ATP independent) was ϳ45% of that seen in healthy individuals (3,5). This suggests that islet cell death occurs in the immediate posttransplantation period (6,7) but may also indicate a functional impairment in the surviving endocrine cells.Experimental investigations (8 -11) on the endocrine function of intraportally transplanted islets have previously been performed by perfusion of whole rat livers containing transplanted islets. Even though this is an elegant approach, it does not enable functional comparisons to be made between endogenous and transplanted islets. Because the volume of the surviving islet mass is unknown, the contribution of islet death versus dysfunction of remaining islets to a poor insulin response is impossible to evaluate. Thus, to approach this problem of functional evaluation of intraportally implanted islets, we applied methods for enzymatic bre...