AbstractIntestinal transplantation has evolved from being considered an experimental procedure into a clinically accepted therapy for patients with intestinal failure and parenteral nutrition life‐threatening complications. Early referral, advances in immunosuppression therapy, standardization of surgical techniques, prophylactic therapy of infections, early diagnosis of rejection, and better posttransplant patient management are some of the changes that have allowed more patients to receive transplants, thus recovering intestinal sufficiency, and at the same time allowing the procedure to spread worldwide. Over the last 2 decades, transplant centers have focused on improving short‐term patient survival, which has consequently increased by >20%. It is now clear that even though isolated intestinal‐transplant recipients have lower mortality risk on the waiting list, they are at higher risk for long‐term graft loss. Mortality is higher on the waiting list and early posttransplant in recipients whose intestinal transplants are associated with liver grafts; however, they have better long‐term patient and graft survival. Nevertheless, 3‐year actuarial patient survival has not changed over the same period of time, and therefore this is our challenge for the next decade. Mt Sinai J Med 79:246–255, 2012. © 2012 Mount Sinai School of Medicine