Chronic pancreatitis causes is associated with exocrine pancreatic failure, and then ultimately endocrine failure requiring insulin therapy. Due to the differential pancreatic blood supply of the endocrine compartment compared to the exocrine tissues, pancreatic islets are relatively spared from destruction by fibrosis until late in the course of pancreatitis. Total Pancreatectomy and Islet Auto Transplantation (TP-IAT) is a highly effective therapy that enables enzymatic digestion of the diseased pancreas and intra-portal islet transplantation. As part of the Australian Islet Consortium we have undertaken TP-IAT in South Australia for high risk peoplewith Hereditary Pancreatitis (HP). A total of 122 individuals with genotype-confirmed HP have been identified. Of these 66 (54%) identify as First Nations Australian people and 66 (54%) fulfilled University of Minnesota eligibility criteria for TP-IAT. Between 2015-2024 14 subjects underwent TP-IAT (8 children [6 female/2 male] and 6 adults [4 female /2male], ages 4-40 years). 13 subjects carried a mutation in the chymotrypsinogen gene (PRSS-1) and 1 subject had the serine protease inhibitor Kazal-type 1 gene mutation (SPINK-1). Mean cold ischaemic time was 11.8 hours (range 10-16 hours). Splenectomy was performed in 4 of 14 cases. For the paediatric group (< 18 years) median IEQ/kg was 9,210 (range 1,126-22,247) and in the adult group (age>18 years) median IEQ/kg was 5,682 (range 3,484-9,535). Total median IEQ isolated in paediatric group was 418,503 (range 28656-65300 ) and in the adults 385,350 (150,268-628,343). All participants remain C-peptide (100%) post procedure, 13/14 (92%) are opiate independent and 6/14 (42%) are insulin free .Importantly HP disproportionately affects Australian First Nations People. We have successfully established TP-IAT as a treatment to prevent Type 3c diabetes in Australia with excellent outcomes