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We describe a new surgical approach for simultaneous liver and kidney transplant in which we utilized the same reverse L incision used for liver transplant to perform ipsilateral native nephrectomy and kidney transplant. The 48-year-old male patient had auto-somal dominant polycystic kidney and significant polycystic liver disease. He underwent multidisciplinary assessment and was listed for simultaneous liver and kidney transplant. The liver and kidney graft were donated from a donor after neurological determination of death. After hepatectomy and orthotopic liver transplant, a right native nephrectomy was performed followed by kidney transplant using the same incision. The transplanted kidney was placed on the right-hand side, with renal artery anastomosed to the external iliac artery, the renal vein anastomosed to the external iliac vein, and the ureter anastomosed to the end of the retained distal native ureter (ureteroureterostomy). Both liver and kidney graft had immediate function after transplant. This case highlights the feasibility and efficiency of a single reverse L incision approach for simultaneous liver and kidney transplant combined with a right-side nephrectomy.