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Introduction Intestinal transplant (ITx) is a treatment option for patients with irreversible intestinal failure (IF) and complications of long-term parenteral nutrition (PN). ITx includes a range of procedures, including both liver and non-liver containing grafts, which differ greatly in indications, clinical outcomes and complication rates. Despite this, ITx outcomes are commonly reported collectively. We aimed to quantify clinical outcomes from patients who had undergone isolated small bowel transplantation (ISBTx).Methods A retrospective review of patient charts who underwent ISBTx at a single UK transplant centre over a 16-year period (01/01/09-31/12/25) was conducted, including demographics, patient and graft survival, incidence of rejection, Graft vs Host Disease (GvHD) and Post-Transplant Lymphoproliferative Disorders (PTLD). Patients who received ISBTx for malignant disease were excluded. Statistical analysis was performed using Kaplan-Meier survival curves (R studio).Results Forty-five patients underwent ISBTx during the study period, with an average age at time of transplantation of 45.5 years (24-63 years). Patient survival at 1 year was 93.3%, at 5 years was 72.3% and at 10 years was 49.7% ( figure 1).Explant of the transplant graft occurred in 11 cases (24%), average time to graft explant 2.7 years. Causes of graft explant were graft ischaemia (4), acute rejection (4), chronic rejection (2) and one for patient choice. Three patients were re-transplanted, while other patients were restarted on PN. There was four cases of PTLD and no cases of GVHD.Acute rejection occurred in 49% of patients. Of these, 23% had grade 1 histological rejection, 27% grade 2 and 50% grade 3. 11% developed chronic rejection. 59% of acute rejection episodes occurred in the first year, and 59% of cases were successfully treated with first-line pulsed methylprednisolone monotherapy. The median hospital stay post-transplant was 51 days (20-197 days), with a median ITU stay of 8.4 days (1-69 days).Conclusions ISBTx for benign IF indications delivers excellent outcomes in a cohort of patients that are at high risk of death if they remain on PN. Rejection remains a significant challenge, although this is treatable if detected early. Most patients achieve nutritional autonomy with excellent quality of life.Abstract O39 Figure 1Kaplan-Meir survival analysis post isolated small bowel transplant