*Purpose: The development and consequences of renal failure after liver transplantation (LT) are well-chronicled. Kidney after liver transplantation (KALT) is the preferred treatment in this setting. Our aim is to demonstrate the advantages of KALT from a single center’s experience over a 30-year period.

*Methods: With institutional IRB approval, we utilized our prospectively maintained research database to obtain information on all patients receiving a liver transplant at our institution, who later received a kidney transplant at our transplant center or another institution.

*Results: We identified 84 patients (60 male:24 female, median age 56 years) who underwent a LT between 1985 and 2011 at our institution followed by a KALT with a median time 7.6 years (range: 96 days to 18.6 years) between transplants. Ten patients had a liver retransplant and one underwent three LTs prior to KALT. The most common indication was calcineurin inhibitor nephrotoxicity (81%). Sixty-nine patients were on dialysis for a median 1.5 years prior to their kidney transplant. Fifty-five patients underwent a cadaveric KALT and 28 by living donation; 1 unknown. Of the cadaveric recipients, twelve were from donors 50 years of age or older. With a median follow up time of 6.3 years after KALT, the 1, 5 and 10-year patient survival rates were 92%, 67%, and 52%, respectively. There was no difference in kidney graft survival between cadaveric and living donors (p=0.32). Patients receiving kidney allografts from donors less than 50 years of age conferred no better survival than recipients of kidneys from donors 50 years of age or older (p=0.91). Five recipients had their KALT within a year of transplant for acute kidney injury: one died from sepsis within two months and the remaining four survived for a median 8.4 years.

*Conclusions: We demonstrate excellent long-term patient survival for LT recipients undergoing subsequent KALT, whether by live or cadaveric, younger or older donors. This suggests a central role for the use of suitable older renal allografts. Finally, we confirm a relevant function for early KALT in recipients developing acute kidney injury post LT.

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