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Organ transplantation is a risk factor for Clostridium difficile infection (CDI). After intestinal transplantation (ITx), few data are available on the impact of this graft infection and the possible induction of rejection.We included retrospectively all children after ITx in our unit, with at least one year of graft survival. All samples positive for Clostridium difficile and its toxin were considered.Among the 57 ITx recipients (60 transplantations), 22 children (39%) developed culture-proven CDI, 12 after isolated small bowel Tx, 9 after liver-small bowel Tx, one after multivisceral Tx. Twenty patients had diarrhea, 8 bloody stools, 4 fever, one hypothermia. Nine were hospitalized for an average of 6.5 days (2-20), four with severe dehydration. Nine (40%) had received antibiotics for an average of 19 days (7-60) before CDI. Two patients were asymptomatic. CDI was treated with metronidazole in 12 children, vancomycin in 6 and both of them in 3. Three children presented mild to severe rejections. Two patients presented concomitantly CDI and rejection. The third patient presented a rejection with severe complications 4 years after CDI. Recurrence of toxinogenic CD was observed in 9 children, in 7 associated with clinical symptoms. During the last follow-up, the stool number was the same as before CDI except for one patient with ongoing infection.CDI is more prevalent in children after ITx compared with other organ Tx; it is most often symptomatic but mildly or moderately severe. Standard antibiotics efficiently control the symptoms. Induction of rejection is a rare event.