FK506 protects against ischemia-reperfusion injury but the mechanisms remain unclear. We investigated the impact of donor pretreatment using FK506 on graft microcirculation and morphology after intestinal transplantation. FK506 was given intravenously to SD rats (0.3 mg/kg) 6 hours before graft harvesting while controls received saline (n = 7/group). Grafts were stored for 3 hours in saline, then transplanted. Preservation induced similar lesions in both groups, but pretreated grafts showed better morphology than controls at 20 minutes after reperfusion. Six hours post-reperfusion, preconditioned grafts revealed near-normal morphology, whereas controls showed short villi, denuded areas, and intense inflammation. Pretreated grafts displayed a lower apoptotic rate and reduced caspase-3 activity. Hsp72 expression was enhanced in preconditioned grafts at harvesting, after preservation, and 20 minutes post-reperfusion compared to controls. Control grafts showed intranuclear p65 (activation of NFkappaB) at 20 minutes post-reperfusion; whereas pretreated grafts displayed no intranuclear p65. However, at 6 hours, comparable intranuclear p65 levels were found in both groups. ICAM-1 was low in both groups after preservation and early post-reperfusion, but greatly increased in controls at 6 hours post-reperfusion. In contrast, pretreated grafts continued to lack ICAM-1. Microvascular perfusion was comparable at 20 minutes. Six hours later, pretreated grafts had 30% increased perfusion, while in controls it was slightly decreased. FK506 alleviated reperfusion injury by blocking NF-kappaB activation and ICAM-1 transcription, thus decreasing endothelial activation and improving the microcirculation. It also induces Hsp72, therefore inhibiting apoptosis and accelerating morphologic restoration.