During the evolution phase of intestinal transplantation, patients with history of abdominal malignancy were cautiously considered for transplantation. This report discusses the therapeutic efficacy of the procedure in this high-risk population. Between May 1990 and December 2005, 188 adult patients underwent intestinal transplantation; 48% intestine alone, 20% liver-intestine and 32% multivisceral. Of these, 14 had histologically documented primary abdominal malignancy; gastrinoma (n=1), GIST (n=1), pancreatic (n=1), colorectal (n=4), hepatocellular (n=1), testicular (n=2), ovarian (n=2), and renal cell (n=2). Short gut syndrome was the primary indication for transplantation in 12 patients due to irradiation enteritis (n=5), surgical adhesions (n=2), volvulus (n=1), vascular injury (n=2), and therapeutic enterectomy (n=2). In the remaining 2 cases, multivisceral replacement was required for portomesenteric thrombosis and radical excision of metastatic gastrinoma. The cancer diagnosis was made before transplantation (1 1/2-32 yrs) in 12 patients and was incidental in the remaining 2. One of the incidental carcinoma was hepatocellular in a multivisceral recipient and renal cell in an isolated intestinal recipient. With a mean post-transplant follow-up of 35 + 38 months, 10 (71%) patients are currently alive with fully functioning grafts. Only 1 of the 4 deaths was due to metastatic adenocarcioma. Despite the need for chronic heavy post-transplant immunosuppression, none of the visceral recipients showed evidence of recurrent carcinoma at the time of death (n=4) or current follow-up (n=10). History or presence of non-metastatic abdominal malignancy should not be considered as an absolute ontraindication for intestinal or multivisceral transplantation.