The number of simultaneous liver kidney transplant has been increasing. This surgery is associated with an increased risk of complications, longer duration of surgery and longer ischemia time to the renal allograft. Two patients listed for liver-kidney transplant at our center underwent en bloc combined liver kidney transplantation using donor splenic artery as inflow. Patient 1 previously underwent cardiac catheterization which was complicated by a bleeding pseudo-aneurysm of the right external iliac artery, which required endovascular stenting of the external iliac artery and embolization of the inferior epigastric artery. Patient 2 was on vasopressor support and continuous renal replacement therapy at the time of transplant. We describe a novel technique of en bloc liver-kidney transplant with simultaneous reperfusion of both allografts using the donor splenic artery for renal inflow. This technique is useful in decreasing cold ischemia time and total operative time by simultaneous reperfusion of both allografts. It is a useful technical variant which can be used in patients with severe disease of the iliac arteries. This article is protected by copyright. All rights reserved.