Addenbrooke’s Hospital Rosie Hospital INTRODUCTION The cumulative incidence of chronic renal impairment in intestinal transplantation is 0.25 at 72 months; it is the highest of all non-renal grafts and is associated with increased mortality by a factor of more than four 1. It is multifactorial and calcineurin inhibitors are thought to play a role. We review the incidence of renal impairment in our cohort and discuss alternative, renal sparing strategies. RESULTS 50 adult patients underwent 56 transplant procedures (22 female; 29 male). 26 procedures were excluded leaving a total of 30. Creatinine was within the normal range for all patients at the time of transplant (median 79μmol/L; mean 87μmol/L; range μmol/L). Mean follow-up was 32 months (median 18 months). Exclusions26 Death <6m7 Re-Tx within 6m2 Kidney containing graft at index5 Kidney containing graft at re-Tx2 Explanted <6m10 Patients <6m post Tx1 Total included30 RENAL IMPAIRMENT POST INTESTINAL AND MULTIVISCERAL TRANSPLANTATION Charlotte Rutter 1, Lisa Sharkey 1, Samantha Duncan 1, Irum Amin 2, Neil Russell 2, Stephen Middleton 1, Andrew Butler 2 1 Department of Gastroenterology, 2 Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK patients switched from Tacrolimus to Sirolimus. Creatinine improved by 10% in 4 patients and normalised in 2 patients. 1 patient developed acute cellular rejection following initiation of Sirolimus which was refractory to medical therapy and required re-transplantation with a kidney containing graft. 3 patients required renal replacement therapy. 1 has been re-transplanted with a kidney containing graft and 2 remain dialysis dependent at home. 1 patient requires intravenous fluid supplementation. CONCLUSION Although small numbers, 57% of our patients develop chronic renal impairment post intestinal and multivisceral transplant. Renal sparing strategies we have adopted include:  Inclusion of colon in the graft  Switch from Tacrolimus to Sirolimus  Continuity surgery to anastomose transplanted colon to native colon  Basiliximab as a bridge to continuity surgery followed by conversion to Sirolimus Observational outcomes of these strategies suggest an improvement in fluid balance and renal function. Further, more detailed analysis of contributing factors, outcomes and morbidity/mortality is needed. References: [1] Ojo AO et al (2003). Chronic renal failure after transplantation of a non renal organ. NEJM. Overall incidence of renal impairment was 57%. 3 patients (10%) had early non-sustained, 3 (10%) had early sustained and 15 (50%) late renal impairment. Contributing factors include high output stoma, renal calculi and recurrent urinary tract infections, sepsis, right-sided cardiac failure and nephrotoxic drugs including calcineurin inhibitors. METHODS  Retrospective review of all patients transplanted in Cambridge between Jan 2006 – Dec 2014  Renal impairment defined as creatinine above upper limit of normal (>125μmol/L)  Early non-sustained - at ≤2 months post transplant with recovery to within the normal range before 6 months  Early sustained - at ≤2 months post transplant without recovery to within the normal range  Late - at ≥6 months post transplant without recovery to within the normal range