Over the past half century there has been a dramatic change in the management of patients with intestinal failure. Most of the initially improved survival was the result of implemantation and availability of total parenteral nutrition (TPN). This required significant resouces because of hospital admissions in the beginning. Then with the development of convenient home-based infusions most patients did well as an outpatient. After many years of evolution, intestinal transplantation is now offered to patients who succumb to the inevitable complications of TPN in the form of infection, catheter-associated thrombosis, hepatic disease, renal disease, persistent gastrointestinal dysfunction and metabolic derangement. Pediatric intestinal failure is a devastating condition, with intestinal and multivisceral transplantation providing an alternative for patients with life-threatening complications of TPN. Recent improvements in immunosuppression, prophylaxis, surgical technique, monitoring and diagnosis of rejection have helped improve the quality of life, graft and patient survival. We reviewed about 188 patients with intestinal/multivisceral transplant between 1994-2013. Some single centers report of five-year patient and graft survival, 80% and 60% respectively. However, evidence suggests generally that five-year patient and graft survival rates after intestinal transplantation are closer to 58% and 40% respectively. Intestinal/multivisceral transplantation is one of the main treatment options in selected group of pediatric patients with intestinal failure.