Intestinal transplantation may become necessary in patients with short bowel syndrome (SBS) who fail intestinal rehabilitation. Most children requiring intestinal transplantation (68%) have SBS due to anatomic loss. Intestinal transplantation can occur in isolation or in combination with other organs. Many children will have advanced liver disease at the time of referral and will undergo combined liver-small bowel transplantation. Considerable progress in immunosuppression has led to decreased rates of acute rejection after transplantation and to improved early allograft survival while minimizing toxicity.Survival with small bowel transplantations has greatly improved over the last 20 years with chronic rejection being the major contributing cause to late graft loss.