Résumé : OBJECTIVE We investigated whether changes in islet autoantibody profile and presence of HLA risk markers, reported to predict rapid β- cell loss in pre-type 1 diabetes, associate with poor functional outcome in islet allograft recipients. RESEARCH DESIGN AND METHODS Forty- one patients received ≥2.3 million β-cells/kg body wt in one to two intraportal implantations. Outcome after 6-18 months was assessed by C-peptide (random and stimulated), insulin dose, and HbA1c . RESULTS Patients carrying HLA-A∗24-positive or experiencing a significant autoantibody surge within 6 months after the first transplantation (n 5 19) had lower C-peptide levels (P ≤ 0.003) and higher insulin needs (P < 0.001) despite higher HbA1c levels (P ≤ 0.018). They became less often insulin independent (16% vs. 68%, P 5 0.002) and remained less often C- peptide positive (47% vs. 100%, P < 0.001) than recipients lacking both risk factors. HLA-A∗24 positivity or an autoantibody surge predicted insulin dependence (P 5 0.007). CONCLUSIONS HLA-A∗24 and early autoantibody surge after islet implantation associate with poor functional graft outcome.