*Purpose: Historically, intestinal retransplantation (Re-ITx) has been associated with high morbidity and mortality.

*Methods: Retrospective chart review of patients who underwent Re-ITx at our institution between 1990-2021 to assess improvements in survival outcome over time and by graft type.

*Results: Two hundred eighty-four children received primary intestinal grafts. 32 patients were listed for retransplantation. One patient died while waiting, 4 are awaiting retransplant and 27 children (9.5%) were retransplanted. 24 patients received a second transplant and 3 a third allograft. Patient demographics are shown in Table 1. Overall 5-and 10-year patient and graft survival were 76.5% and 51.7% and 75.1% and 51.0%, respectively, with mean follow-up of 89 months. (Figure 1A&B) 75% of patients attained full nutritional autonomy. Median graft survival for liver-contained (liver/intestine or MV) graft recipients was 183 months compared to 59.7 months for isolated intestinal retransplants. (Figure1C)

*Conclusions: Modern immunosuppression protocols, technical advances, and multidisciplinary management of children with intestinal failure, have led to favorableoutcomes and survival in patients with Re-ITx and recipients of liver-containing allografts.

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