Objective To evaluate the outcome of liver transplantation (LT) or combined liver-kidney transplantation (CLKT) for acute-on-chronic liver failure (ACLF) patients with renal dysfunction.Method From January 2001 to December 2009,133 patients underwent LT for ACLF at our center.Among them,30 had both ACLF and renal dysfunction.Of the 30 patients,12 underwent CLKT for end-stage renal disease (ESRD),and the other 18 with hepatorenal syndrome type 1 (HRS1) underwent LT alone.Their clinical data were reviewed and their survival outcomes were compared.Result The median model for end-stage liver disease scores (MELD) of the patients with ACLF were 28.133 patients received deceased donor liver grafts and 12 patients also received the same deceased donor kidney grafts,The hospital mortality rate was 21.8％ for all patients with ACLF.The 5-year survival rates were 72.8％ for patients without renal dysfunction and 70％ for patients with renal dysfunction.The curative effectiveness of the patients with ESRD who underwent CLKT was better than that of the patients without renal dysfunction or the patients with HRS1 who underwent LT alone.Conclusion LT alone improved renal function in most patients with HRS1.Simultaneous liver-kidney transplantation is an excellent strategy in patients with both ACLF and ESRD.It provides protection to kidney allograft in liver-based metabolic diseases affecting the kidney.