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Total pancreatectomy (TP) and islet auto-transplantation (IAT) is a treatment for chronic pancreatitis; however, its projected success largely relies on transplanted islet equivalent, and defined by post-surgical insulin-injection independence and HbA1c. Endocrine-cell dedifferentiation has been suggested to contribute to metabolic failure in type 2 diabetes, shown by the co-localization of insulin with glucagon and/or vimentin. Here, we correlate islet phenotypic identity with pre- and post-surgical metabolic function following TPIAT in two patients.Metabolic function was compared with histological assessment of endocrine cells demonstrating variable co-expression of insulin and glucagon.Patient 1 demonstrated high endocrine cellular phenotypic maintenance and remained insulin-injection free at study completion.Endocrine-cell dedifferentiation was identified prior to TPIAT, which correlated with pre- and post-surgical endocrine function and transplant endpoints, and may contribute as a predictor of interventional success.Vivian Smith Foundation. Brown Foundation.