*Purpose: Isolated and multivisceral intestinal transplantation is indicated for patients with life threatening complications of intestinal failure. Intestinal retransplantation has been performed in select intestinal transplant recipients, who have allograft failure or loss. Intestinal retransplantation is historically associated with higher mortality and morbidity, although recent studies have demonstrated comparable results to first time transplant recipients in regard to patient and graft survival. We review our most recent experience with intestinal retransplantation, focusing on outcomes of graft function, graft survival, and overall patient survival.

*Methods: A single center retrospective study was performed to compare the outcomes of primary (first time) intestinal transplants with retransplantation. Inclusion criteria were adult and pediatric intestinal transplant recipients between 2009-2014.

*Results: A total of 82 intestinal transplant procedures were evaluated, of which 19 were retransplants (23.2%). Patient and graft survival (Figure 1A and 1B) were not found to be significantly different between primary intestinal transplants and retransplants (Figures 1A and 1B) (p=0.551 and p=0.747). Patient survival following primary transplantation was 83, 76, and 70% at 1, 3, and 5 years respectively, compared to 84, 74, and 68% for retransplantation. Graft survival, defined as time without allograft explant, in primary intestinal transplantation was at 76, 60, and 52%, compared to retransplantation at 84, 74, and 68%. Multivisceral transplant recipients had equivalent patient survival (Figure 1C, p=0.883), however significantly higher rates of graft survival than isolated intestinal transplants (Figure 1D, p=0.004). Lower graft rejection was experienced in multivisceral intestinal transplant recipients (36%), compared to isolated intestinal transplants (69%, p=0.006). Excluding isolated intestinal transplants, outcomes of multivisceral transplants between primary and retransplants were not significantly different in regard to patient survival and graft survival (Figures 1E and 1F, p=0.307 and p=0.231).

*Conclusions: Intestinal retransplantation can have similar outcomes to primary transplantation in select recipients. Additionally, graft survival in multivisceral intestinal transplantation is superior to isolated intestinal transplantation.

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