PURPOSE OF REVIEW: Although intestinal transplantation is uniquely suited for the treatment of patients with intestinal failure suffering from life-threatening complications, patient survival at 5 years remains suboptimal at approximately 50-60%. RECENT FINDINGS: The introduction of effective medications to improve intestinal absorption, alternate intravenous lipid preparations that may reduce cholestasis and a technically easier nontransplant intestinal lengthening procedure have largely changed the available options for nontransplant interventions. Multidisciplinary teams created to manage the complexities of this population have shown improved outcomes and the ability to prevent or slow progression of life-threatening complications that would otherwise lead to intestinal transplantation in a large number of patients with short bowel syndrome. SUMMARY: Here, we review the historical options, recent advances and cutting-edge research that will likely provide the basis for further advances in the treatment of patients with short bowel syndrome as the cause of their intestinal failure.