Introduction: Combined liver kidney transplantation (CLKT) can improve liver allograft and overall survival in patients with end stage liver and renal failure. We aimed to analyse our experience and confirm that there is still a role for this procedure in modern transplantation.Methods:A retrospective analysis of patient notes and electronic records was performed. All CLKT performed at a single centre were included.Results:A total of 31 CLKT were performed in 30 patients at a single centre over a 26 year period. In 15 the indication was a metabolic disease, principally methylmalonic acidaemia and primary oxalosis; of the remainder 6 had alcoholic liver disease and 3 had hepatitis C with associated renal conditions, 2 had polycystic disease and 3 were re-transplants. Mean donor age was 37 years (7-71); when separated into subgroups prior to 2010 and from 2010 onwards, the later group were significantly older (43 vs 34 years). 2 donors were DCD, both performed in 2013. Mean liver cold ischaemia time was 582 minutes and mean kidney CIT was 799 minutes. 21 patients remain alive, 19 patients have functioning CLKT liver allografts, and 17 patients have functioning CLKT renal allografts after a median follow-up of 57 months (7 days-25 years). Causes of death were multiple organ failure (6), septicaemia (1) and mesenteric infarction (1). Causes of liver allograft failure leading to re-transplant were vascular thrombosis (2), primary non-function (1) and ductopenic rejection (1). Causes of renal allograft failure were primary non-function (1), DWFG (7), cellular rejection (2), sepsis (2) and cessation of immunosuppression (1). There were 3 renal delayed graft functions; 2 of these and the only PNF were in the older post 2010 subgroup. Discussion:CLKT is an appropriate and safe treatment for select group patients. Ischaemia times, complications and outcomes are similar to transplanting either organ alone. The recent increase in renal delayed graft function reflects an increasing reliance on older donors. Liver and kidney teams need to offer a combined approach to management of these patients in order to achieve the best outcomes.