In the past decade with the introduction of induction protocols based on anti-lymphocyte antibodies, 1 year graft and patient survival rates comparable to other organ allografts were achieved. Intestinal transplantation should be considered for patients with irreversible short gut syndrome (SGS) or functional intestinal failure and severe complications of PN. Donors should be hemodynamically stable and without the evidence of intestinal ischemia; donor size is also important. The selection of an ABO identical donor is preferred; however, ABO compatible grafts have been used when identical donors were not available. Intestinal transplantation may be combined with other organs, for example, liver. This chapter describes in detail histologic criteria for acute and chronic cellular rejection, humoral (C4d mediated) rejection), surgical complications, infections, recurrent disease, and long term outcome.