WE have performed one multivisceral (MV), two cluster, and one combined liver plus small bowel (LSB) transplantation since October 1998. The MV recipient was a 5-year-old girl with secretory diarrhea, total parenteral nutrition (TPN)-induced liver cirrhosis, and several lifethreatening episodes of line infections. Two male patients, 44 and 57 years old, diagnosed to have neuroendocrine tumors of the pancreas (NEPT), received cluster grafts, including the liver, stomach, duodenum, pancreas, and approximately 50 cm of small bowel. The LSB recipient was a 57-year-old woman with short bowel syndrome and TPNinduced liver cirrhosis. All donors were ABO identical, 50% to 100% of recipient’s body weight, and CMV-positive except in one case. The cold ischemia time ranged from 4 to 6.5 hours. Immunosuppression included Prograf, Cell Cept, and steroids for the MV recipient. She had one severe biopsy-verified rejection episode on day 13 posttransplant that required exploration and segmental intestinal resection due to perforation. This episode responded to OKT3 and steroid bolus therapy. The TPN was discontinued approximately 1 month after transplantation. She is currently well and displaying satisfactory growth and development 3 years after transplantation. Stomal output, however, remains high, for which she requires regular crystalloid infusions. The first cluster recipient with NEPT was maintained on an immunosuppressive regimen consisting of Prograf, Cell Cept, steroids, and an initial ATG infusion. He had multiple rejection episodes, of which one was treated with OKT3. He later received rescue treatment with Sirolimus and has since then been free of rejections. He is currently at home, 20 months after transplantation, on full enteral nutrition and without signs of tumor recurrence. The second cluster recipient was given Sirolimus at the time of transplantation in combination with Prograf, Zenepax and steroids, with a Sirolimus target level of 10ng/mL. Target FK was 15 to 25 ng/mL during the first 3 months after Tx for all patients. This patient died 18 weeks’ posttransplant due to disseminated lymphoproliferative disease in the lungs and liver. The recipient of the LSB graft was transplanted on September 1, 2001. She received FK 506, Zenepax, and steroids. She has been free of rejection episodes 6 weeks after her transplant, on full enteral nutrition, and she has normal liver function.