The prognosis of short gut syndrome has improved dramatically in the past few decades through the development of total parenteral nutrition (TPN). However, TPN-related complications still produce major problems for such patients. Intestinal transplantation can significantly improve patients' prognosis and increase their quality of life. The international intestinal transplant registry is updated every other year in an international small bowel transplant symposium. In this report we review the indications, procedures, management, and current status of intestinal transplantation based on the 11th International Small Bowel Transplant Symposium held in Bologna in 2009. The major findings of international studies have shown that optimization of the following factors may contribute to better outcomes: advancement of surgical techniques, new immunosuppressive techniques, improvement of postsurgical management, adequate timing of transplantation, and refined selection of candidates. Ideally, intestinal transplantation will be established as a standard therapy for intestinal failure and secondary multiorgan failure by improving the long-term survival and quality of life for patients receiving such transplants.