BACKGROUND: Crohn's disease (CD) is a chronic and progressive inflammatory bowel disease. Despite advances in medical therapy, half of patients still require an intestinal resection 10 years after diagnosis, and a third will require another repeat resection within the next 10 years. A progressive reduction in small bowel length may lead to short gut syndrome and need for long-term total parenteral nutrition (TPN). Intestinal transplantation is indicated in these patients who develop TPN-associated liver failure, loss of vascular access, and recurrent catheter-associated sepsis. Published data on post-transplant outcomes are currently sparse and in small groups of patients. Our primary aim is therefore to characterize long-term risk of rejection, graft failure, and death in the largest cohort of intestinal transplantation for CD in the United States. METHODS: The study included all adults who underwent intestinal transplantation between May 1990 and November 2013, as recorded in the U.S. Scientific Registry of Transplant Recipients. Data were collected on patient demographics, body mass index (BMI), waitlist time, and transplant indications. Outcomes included allograft rejection, graft failure, TPN resumption, and survival. Cox proportional hazards analyses were used to evaluate time to events, comparing CD patients with non-CD intestinal transplantation recipients. Multivariable analyses were adjusted for age at transplantation, sex, race, BMI, and time on waitlist. RESULTS: There were 976 adults who underwent 1069 intestinal transplantations from 1990 through 2013; 134 (12.5%) were for CD (Table). Patients were followed for a median of 36 months and a maximum of 60. At transplantation, CD patients had a mean age of 44.7 years, mostly normal or overweight BMI (73.9%), <6 months on the waitlist (76.8%), and not hospitalized (80.6%). Actuarial risk of acute rejection was 22.4% at 1 year, 38.1% at 3 years, and 42.7% at 5 years, while risk of graft failure was lower at 5.6%, 16.8%, and 19.2%, respectively. Patient survival was 69.2%, 62.0%, and 62.0% at 1, 3, and 5 years, respectively. In multivariable analyses, CD patients had a similar risk of acute rejection (hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.59 1.24; P = 0.40), graft failure (HR 1.70; 95% CI 0.91 3.17; P = 0.09), resumption of TPN (HR 1.48; 95% CI 0.93 2.35; P = 0.10), and death (HR 1.07; 95% CI 0.70 1.64; P = 0.77) as non-CD patients. CONCLUSION: In the largest reported cohort of CD patients undergoing intestinal transplantation, long-term outcomes were similar for CD and non-CD indications. Intestinal transplantation should be considered for CD patients with intestinal failure. Patient Characteristics