*Purpose: Simultaneous liver and kidney transplantation (SLK) is indicated in patients with concomitant end stage liver disease and severe chronic kidney disease or end stage renal disease. The number of SLK performed in USA has consistently been increasing in last few years. Traditionally SLK is performed using a subcostal incision for the liver allograft and a lower abdominal incision for kidney transplantation (Dual Incision, DI). At our institution, we perform a single subcostal incision (SI) for SLK. Aim of our study was to report our outcomes using single and dual incisions for SLK.

*Methods: Retrospective analysis of all SLK done at our center from 01/2015 to 11/2020 was performed. Demographic characteristics, complications, intraoperative findings and complication after SI and DI were statistically compared. Further subgroup analysis was performed based on early and late experience with SI SLK.

*Results: A total 34 SLK were performed (18 DI and 16 SI) during study period. MELD score, age, and indications for transplant were comparable in both groups. Recipient demographics, outcomes and comparison between two groups are shown in table 1 and 2. Patient in SI group had higher BMI without any statistical significance. Cold ischemic time of kidney transplantation was significantly shorter in SI group (p=0.002). The complications were slightly higher in SI group in early era without any statistical significance. Hospital stay, warm ischemia time were comparable in both groups. Post-operative morphine requirements and overall operative time in SI group was lower.

*Conclusions: Single incision SLK is technically feasible and has comparable outcome to dual incision SLK. Single incision SLK was associated with shorter cold ischemia time for kidney transplant as well as lower overall operative time without any impact on outcome. Further study is required to delineate additional benefit of single incision SLK with particular focus on patient acceptance and recovery from the surgical wound.

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