I. Overview of small bowel transplantation: Canine models of small bowel transplantation (SBT) and abdominal multivisceral transplantation were reported as early as 1960 by Lillehei and Starzl, whereas the world’s first successful liver-intestinal co-transplantation was not performed until 1989 by Starzl and Williams almost simultaneously reported by Starzl and Williams, but both patients died of B-cell lymphoma at 109 and 192 days postoperatively, respectively. The first combined liver-intestinal transplant with long-term survival was performed by Grant in 1989. During 1989-1991, successful cases of small bowel transplantation alone were reported by Deltz, Goulet, and Starzl, respectively. The earliest clinical attempts at small bowel transplantation were carried out at the same time as liver and kidney transplantation; however, the results of small bowel transplantation were poor, and lymphoid tissue-rich small bowel allografts could cause a strong and uncontrollable host-versus-graft reaction (HVG), severe infections, and graft-versus-host reaction (GVHD). Indications for small bowel transplantation The small bowel is an important organ for maintaining nutrition and survival of the human body, but due to trauma, vascular lesions, intestinal lesions, or congenital malformations that cause loss of the organ or small bowel function in some patients, irreversible intestinal dysfunction occurs, and the minimum amount of nutrients and water-electrolyte balance required by the body cannot be maintained. Intestinal Failure is defined as the loss of normal nutritional support and the need for total parenteral nutrition (TPN). Prolonged use of TPN can lead to small bowel failure syndrome, which is characterized by lack of venous access, fatal infections, and TPN-induced cholestatic liver disease. Patients with small bowel failure have a mortality rate approaching 70% within 1 year, and the only hope for survival is allogeneic small bowel transplantation. The current internationally recognized indication for small bowel transplantation is: “Small bowel transplantation is the most desirable therapeutic option for patients with irreversible intestinal failure who are unable to tolerate TPN or who also have severe complications of TPN.” According to several international small bowel transplant centers children account for approximately more than 2/3 of the total number of patients undergoing small bowel transplantation, and the indications for which are predominantly congenital malformations (see accompanying table). Small bowel transplantation should be considered clinically in the following situations: loss of central venous access, fatal multisystem organ failure due to infection, and persistent and progressively worsening jaundice. TPN-induced cholestatic liver disease is the most serious complication, with persistent jaundice rapidly progressing to end-stage liver disease, followed by a “domino” effect of renal and pancreatic failure.