Highlight
· Combined liver–kidney transplantation has evolved into a critical treatment option for patients with simultaneous end-stage liver and kidney failure over the last 40 years.
· Surgical innovations, including the novel Sun technique for simultaneous orthotopic transplantation using a single incision, have improved procedural efficiency and patient outcomes.
· Immunosuppressive therapy remains challenging, with calcineurin inhibitors enhancing short-term graft survival but limited progress in long-term outcomes; biomarker-guided approaches and patient adherence interventions are emerging.
· Xenotransplantation utilizing gene-edited pig organs signals a potential paradigm shift, although still investigational.
· The absence of global standardized criteria for organ allocation and patient eligibility highlights the need for consensus to reduce variability and optimize outcomes.
