Intestinal transplantation has continued to evolve over the past decade. Fewer patients have received intestine transplants in the past 5 years, perhaps due to efforts in intestine rehabilitation. Despite improvement in earlier outcomes, long-term survival has remained steady over the past decade. This is potentially due to the complications of immunosuppression, as well as inherent poor graft half-life due to chronic rejection. Improvements in outcome will require multidisciplinary efforts to understand the long-term mechanisms of intestine graft acceptance and to properly optimize and individualize immunosuppression for the transplant recipient.