Aim: Intestinal re-transplantation (Re-IT) is becoming a relatively common procedure as the number of long term survivors increases. However, no clear consensus has been achieved regarding the limits for Re-IT. Our aim was to analyze the results of intestinal re-transplantation.

Patients and Method: We retrospectively reviewed the records of pediatric patients who underwent Re-IT at our center (1999-2017). Survival, type of primary and subsequent grafts was included in the analysis.

Results: A total of 100 intestinal transplants were performed (1999-2017) in 79 patients. RE-IT were performed in 15 patients: 9 required a second graft, and 6 received a third graft. Distribution by type of primary and subsequent graft was as follows: SB-MVT (7), SB-SB-MV (5), SB-MV-MV (1), SB-CLSB (1), CLSB-CLSB (1) and MV-MV (1). Of the 6 patients that received a third graft, 5 had a previous isolated bowel and 1 had a MV graft, all of them underwent Re-TI with a MV graft. The 5 patients that underwent RE-IT with an isolated bowel required a third graft. Causes of primary graft loss were ACR (12) (+DSA, 2), CR (2) (+DSA, 2) and lymphoma (1); while causes for secondary graft lost were ACR (3) (+DSA, 2), CR (1) (+DSA, 1) and malignancy (2). Overall survival of RE-IT and non RE-IT patients were 60% and 64% respectively. No patient survived RE-IT when the previous graft included the liver (2MV-MV and 1CLSB-MV)

Conclusions: In our experience, survival after RE-IT was comparable to long term survival of our main series.
However, RE-IT with an isolated bowel graft ended up in graft lost in all cases, and no patient survived RE-Tx in the long term when the previous graft included the liver.
The limited number of cases warrants further research before recommendations regarding the limits of RE-IT can be defined.