*Purpose: We sought to investigate whether race-matching in small intestine (SI) transplantation correlates with better transplantation outcomes, as well as lower odds of graft rejection.

*Methods: Recipient and donor SI transplant data were obtained from 2010-2021 from UNOS STAR files. We analyzed pediatric and adult SI transplants separated into groups of SI transplants without liver and SI transplants with liver. The same groups were also stratified by race and by low vs high HLA-mismatch level. The groups were analyzed via logistic regression for effects on graft and patient survival, graft dysfunction and survival. All statistical analysis was conducted in GraphPad Prism 9.3.0 (345) for Mac, GraphPad Software, San Diego, California USA, www.graphpad.com.

*Results: Race-matching in pediatric liver-excluded SI transplants is associated with better graft survival. In contrast, low HLA-mismatch level is associated with shorter graft survival. However, neither has an effect on overall patient survival. Neither race-match nor HLA-mismatch levels has an effect on adult liver-excluded SI transplants, or pediatric and adult liver-included transplantations in terms of graft and patient survival.

In addition, race-matched pediatric liver-excluded transplants had higher odds of graft survival and lower odds of graft failure due to rejection. In addition, graft-related deaths were lower in the race-matched groups.

*Conclusions: The odds of graft survival are greater when pediatric liver-excluded SI transplants are race-matched. In pediatric liver-excluded transplants, race-matching does not correlate with better patient survival, but it could reduce graft failure-related deaths if other efforts are made to reduce other causes of death. Also, race-matching is a potential strategy to improve graft survival than matching HLAs.

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