Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease characterized by inflammation and fibrosis of the intra- and extra-hepatic bile ducts. Within 10 years after diagnosis, about half of PSC patients progress to end-stage liver disease and receive a life-saving liver transplant. Due to the lack of effective medical treatment for this disease, liver transplantation remains essential in PSC care. Unfortunately, a third of PSC patients experience graft failure due to various reasons including recurrent disease. Liver re-transplantation (re-LT), a controversial practice in an era of organ shortage, becomes the only alternative to death. Despite this, liver re-transplantation in PSC patients has not been well studied. Research to identify modifiable factors could guide clinical management of post-transplant PSC patients and prevent the need for re-transplantation. We conducted a retrospective, single-center cohort study of all consecutive liver transplants from 1990-2021 at the Dumont-UCLA Transplantation Center. Of our 6,118 transplants, 233 were performed in 198 recipients with a PSC diagnosis. Fourty-eight were liver re-transplantations, of which 11 were early re-LT (≤30 days after first transplant) and 37 were late re-LT.  Indications for re-transplantation in PSC patients were acute rejection (2, 4.2%), chronic rejection (14, 29.2%), primary non-function (2, 4.2%), early allograft dysfunction (2, 4.2%), hepatic artery thrombosis (9, 18.8%), portal vein thrombosis (2, 4.2%), recurrent disease (15, 31.3%), and other (2, 4.2%). From Kaplan-Meier survival analysis, late re-LT PSC patients had superior survival to PSC patients who received 1 transplant and were never re-transplanted (p=0.0247.) Causes of death included graft failure, multiorgan failure/infection, cardiopulmonary failure, cerebrovascular failure, malignancy, and unknown/other. Re-transplanted patients were 2x more likely to expire from multiorgan failure/infection (p<0.05). To the best of our knowledge, this is the largest cohort of re-transplanted PSC patients and the first retrospective chart-based study on re-transplantation in PSC, allowing unique insight into the natural history of PSC. Ongoing analyses include competing risk analysis of time to retransplant using death as a competing risk and cox proportional hazards regression analysis of overall survival using re-transplantation as a time-dependent covariate.