Liver transplantation remains the best treatment for end stage liver disease. The case report highlights the immunological work-up of a woman with end stage kidney disease and liver disease. As liver is less immunogenic in terms of immune tolerance, either a combined liver and kidney transplantation or a liver followed by a kidney transplantation from the same donor significantly reduces the rejection episodes. Compared to other transplanted organs, liver allografts require lower doses of immunosuppression and exhibit a lower incidence of chronic alloimmune-mediated graft injury. The presence of various immune-active cells, coupled with the potent immunoregulatory properties of liver-derived MSC, contributes to reduced rejection rates and improved graft survival.