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The prevalence of paediatric home parenteral nutrition (HPN) has been rising over the last two decades in the UK. The relative contribution of increased survival or incidence is unclear. UK Longitudinal survey of HPN outcomes have incomplete ascertainment. We present over 20 years of Scottish HPN data. Including incidence, point prevalence, demographic trends and outcomes of HPN patients within Scotland from 2003-2025, examining data from all 3 Scottish regions (representing 7.1% of UK population <16yr). 1 2Point prevalence (31st October annually) and incidence rates of HPN for 2003-2025 were evaluated. Demographics included age, diagnosis (short bowel syndrome [SBS], Neuromuscular [NM]; mucosal). Outcomes were defined as: still on PN; weaned off PN; transplanted, death; transitioned to adult service; lost to follow up. Two-year transplant-free survival (excluding deaths not attributable to IF/HPN) was also calculated.3 Patients were divided by epoch of first HPN episode; 2002-2008, 2009-2014, 2015-2019 and 2020-2025. Statistical analysis was performed using t test, Mann=Whitney test and Poisson regression where appropriate.91 cases (57% female) received 106 HPN episodes with 119,976 total HPN days. Median age at first HPN episode was 1.47 years (range 0.25-16.08 years). Distribution of aetiologies were 58% SBS, 25% NM and 17% Mucosal. In the fourth epoch there was a large increase the proportion of NM (47%) having previously been 17%-18%.Median time on HPN was 608 days (range 8-6790 days). Most recent point prevalence was 16.7/1,000,000 Scottish population under 16 years. Median point prevalence had been rising from epoch to epoch but has stabilised in the fourth epoch at 20.7/1,000,000. Yearly incidence rates ranged from 0.01-0.11/1,000,000/year. Median incidence rates across epochs is at a study low in the most recent epoch at 0.03/1,000,000 (0.03-0.06/1,000,000)At study end, 24 (26%) were on PN at last review, 43 (47%) weaned, 19 (20%) died, 4 (4%) transitioned to adult services on PN, and 1 (1%) patient transferred outside Scotland. In first 22 years of study 4 patients transitioned on PN, we identify 8 patients approaching transition in next 2 years (0.2 per year vs 4 per year, p<0.001)). Extrapolating this data across the United Kingdom would equate to ≠ 110 young people on HPN approaching transition to adult services.2-year transplant free survival of HPN significantly improved from the two earliest epochs to the third (69% and 87% to 100% (p=0.02 and 0.05 respectively). There was a non-significant reduction in transplant free survival from third to fourth epochs (100% to 94%, p=0.34) (figure 1).We report the first longitudinal national survey of outcomes for >20yrs data for HPN in the UK with complete ascertainment and outcomes for cases. Our data shows that incidence is stable and prevalence had been rising. Rising prevalence is a reflection of improved survival rates for patients and our most recent data compare favourably with international centres of excellence.3 Development of improved transitional services is now a priority for Scottish HPN services and HPN services across the UK over the next epoch.References https://www.nrscotland.gov.uk/publications/population-estimates-time-series-data/ (accessed 3/11/2025)https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualmidyearpopulationestimates/mid2024#age-structure-of-the-population (accessed 3/11/2025)Abi Nader E, Lambe C, Talbotec C, et al. Outcome of home parenteral nutrition in 251 children over a 14-y period: report of a single center. Am J Clin Nutr. 2016;103(5):1327–1336. doi:10.3945/ajcn.115.121756Abstract OC8 Figure 1Percentage transplant free survival in new HPN patients by epoch