Purpose: Intestinal retransplantation is required in more than 10% of long term survivors, especially in those who underwent isolated intestinal transplantation. However, no clear guidelines are available regarding indications, type of graft and immunological management. Our aim is to report our experience after retransplantation in children.

Material and methods : A retrospective study of pediatric intestinal retransplantation performed in our center in the last 15 years (2003-2018) was conducted.

Epidemiological and anthropometric data, number of grafts received by each patient and the type of these with or without liver inclusion, causes of graft loss and recorded DSA data were analyzed.

Results: A total of 18 patients were retransplanted (male predominance, mean age of 5.5yrs), 12 of them twice and 6 three times, totaling 42 grafts implanted. The liver was included in the graft in 22 (4 liver-intestinal -CLSB- and 18 multivisceral -MV-). Overall survival after 5yrs was similar in children undergoing transplantation compared to our general series (63 vs 73%).

Regarding the type of graft, survival after 1 and 5yrs for isolated bowel and liver-including grafts was 20% and 0% vs. 68 and 61% respectively (p<0.05).

Preformed DSA were present in 6 cases (14%), 3 of them lost their second grafts. And 2 patients (5%) developed de novo DSA and lost their non-liver included grafts (SB).

Conclusions: Retransplantation in children had long term outcomes similar to the main series. Liver-including grafts showed much better survival. Preformed or the novo DSA had negative impact on graft survival that was attenuated by the presence of the liver. Further studies are warranted to provide better understanding of the role DSA on these patients.