*Purpose: Since the introduction of the Model for End-stage Liver disease (MELD) criteria in 2002, more combined liver kidney transplants are performed. Until 2017, no standard allocation policy for CLKT (Combined Liver Kidney Transplant) was available and each transplant center decided eligibility on a case-by-case basis for CLKT or Liver Transplant Alone (LTA). The aim of this systematic review was to compare the clinical outcomes of CLKT and LTA in patients with and without renal dysfunction.

*Methods: We compared patient and graft survival in CLKT and LTA by conducting a systematic literature review from January 2000 through July 2020. To provide equal comparisons, we stratified our analyses into two groups according to whether renal dysfunction was also present in the LTA recipients.

*Results: In total eleven studies were included in this review. Three studies compared CLKT to LTA in the presence of renal dysfunction and showed no significant difference in mortality risk at 1, 3 and 5 years (RR 1.03 [CI 0.97-1.09]; RR 1.06 [CI 0.99-1.13]; RR 1.08 [CI 0.98-1.19] respectively). Two studies compared CLKT to LTA in risk of liver graft loss at 1 and 3 years with a significant difference in favor of CLKT at 3 years (RR 1.10 [CI 0.93-1.30]; RR 1.15 [CI 1.08-1.24] respectively). Seven studies compared CLKT to LTA without renal dysfunction, showing no significant difference in mortality risk or risk of graft loss.

*Conclusions: In conclusion, CLKT seems to be an appropriate therapeutic option for patients with both end stage liver and renal dysfunction. However, more data is necessary which KDIGO stage of renal dysfunction benefit the most from CLKT.

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