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The field of intestinal transplantation continues to grow, both in terms of overall transplants performed each year and number of centers adopting this procedure. Numerous advances in technical and management procedures have resulted in improvements of patient and graft survival. This review focuses on the technical advances that have emerged over the last year.Multiple variations of the original technique of intestinal transplantation are now utilized according to the patients' original diagnoses and/or degree of liver dysfunction. Multivisceral grafts can include both donor spleen and large intestine; preservation of the native spleen and pancreas is possible in some cases. Living donor intestinal transplantation is being described as alternative technique to minimize death on the waitlist.Constant evolution in the surgical aspects of intestinal transplantation parallels the improvements that have taken place in the medical management and immunosuppression. The transplant surgeon with full knowledge of all variations of intestinal transplant techniques will be able to tailor the type of surgery to each individual patient.