In France, islet transplantation (IT) is reimbursed in T1D with severe hypoglycemia (ITA), or who already receive immunosuppression for a kidney transplant (IAK). The aim of this study was to analyze the outcome of IT patients for at least 10 years. Patients and methods: Between March 2003 and February 2023, 65 patients received an IT in a University Hospital (48 ITA (23 male), mean age 45 (range 32-61) years, and 17 IAK (8 male) mean age 47 (range 35-64) years. Of these 65 patients, during this first decade, 5 ITA (2 male), back to insulin with an undetectable C-peptide, were lost of follow-up, after a mean 6-year period, with a mean duration of insulin-independence of 19.6 months. Three IAK patients (2 male) died at a mean age of 61.3 years , after a follow-up of 5.6 (range:3-10) years from lymphoproliferative cell disorder (PTLD), stroke and clostridium colitis, respectively. All were treated with insulin, with a mean fasting C-peptide level at 1.25 (range:0.4-1.75) ng/mL. Of the 57/65 remaining patients, 31/65 had more than 10 years of follow-up. Four/31 patients (all female) were still insulin-independent (I ITA-3 IAK) with a betascore at 1 month and 1 year at 7 (n= 1) or 8 (n= 3). Their betascore at last news varied between 5 and 8, fourteen (n=1), 16 (n=1) and 17 (I ITA, 1 IAK) years after IT, respectively. The blood creatinine level was between 1.3 and 1.5 mg/dL. Besides the 4/31 insulin-independent patients, 3/31 patients had a betascore >3 with insulin requirements <0.25 IU/kg/d (vs. 0.40 before IT). Twenty-four patients (16 male) had a betascore <3 with a mean follow-up of 15 years and a duration of insulin-independence of 50 months; 20/24 were treated with a sensor-associated insulin pump, whom 4/24 in closed loop and another 2 with automated discontinuation of insulin in case of hypoglycemia. During this second decade, 4/31 patients, aged 66.5, died in average 14 years post-IT after a mean 9-year period of insulin-independence (1 female ITA over 70 years with severe cognitive disorders and undetectable C-peptide, 3 IAK with C-peptide > 0.3 ng/mL whom 1 male from skin PTLD, and 2 females from rectal carcinoma and unknown cause). One month and 1 year after IT, the proportion of the 31 patients bearing an HLA type DR3-DR4 was equivalent to those with other types of HLA at the time. Over time, the median betascore tended to be lower in the group bearing DR3-DR4 HLA type that usually favors diabetes as compared to the patients bearing other HLA types. Conclusion: In this cohort of 65 IT patients, 5 were lost of follow-up with undetectable C-peptide and 3 died with blood C-peptide > 0.3 ng/ mL during the first decade. From the 31 patients with a follow-up of at least 10 years, 4 patients died, mainly IAK; 7/31 patients (3 ITA and 4 IAK), mainly female had a betascore > 3, whom  more than half remained-insulin independent 14 to 17 years after IT.