*Purpose: Although both pancreas transplantation alone (PTA) and islet cell transplantation (ICT) have been associated with peri-operative declines in eGFR, the magnitude of decline is far less than that associated with medically managed (MM) diabetes. In the long-term, PTA and ICT have demonstrated stabilization of chronic kidney disease (CKD) for type 1 diabetic patients. In this setting, it remains unclear whether PTA/ICT transplantation reduces future need for kidney transplantation and mortality.

*Methods: A decision analytic Markov state transition model was created to simulate the life of type 1 diabetic patients with CKD who underwent one of three interventions: 1) PTA, 2) ICT, or 3) MM. Estimated declines in eGFR, chance of requiring kidney transplant, and mortality were calculated following each intervention for a simulated cohort of 3,000 patients. Base case patients were defined as 30 year old type 1 diabetic patients with an initial eGFR of 30 ml/min/1.73². Sensitivity analysis of initial eGFR was performed. Markov model parameters were extracted from literature review.

*Results: PTA and ICT was associated with improved long-term survival across a spectrum of initial eGRF (15-60 ml/min/1.73²). For base case patients, ICT patients required fewer transplants, and gained 17.8 years of life compared to MM patients, and 3.8 years of life compared to PTA patients.

*Conclusions: ICT is associated with stabilization of eGFR, thereby reducing need to future kidney transplantation and improving long-term survival.

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