In the past 15 years, since the first successful long-term survival after small bowel transplantation, there has been a dramatic improvement in outcomes. Small bowel transplantation is now the best option for patients with intestinal failure with life-threatening complications. During this past year a consensus conference agreed on a set of standard indications for small bowel transplantation heralding a major milestone for this field. Other major developments include the demonstration of the need for early referral, the introduction of novel immunotherapy, better control of cytomegaly virus and Epstein-Barr virus, and recognition of the unacceptably high mortality rate for combined liver and small bowel transplantation candidates awaiting transplantation.