Kidney or liver transplantation is a standard therapeutic procedure if one of these organs fail. However, the need for transplantation of both organs may arise with deterioration of organ function especially in hepatorenal syndrome patients. Hepatorenal failure patients are at increased risk for management intraoperatively, because they have complex problems such as renal failure related to volume overload, hyperkalemia, and uremic syndrome. These days, intraoperative use of hemodialysis or ultrafiltration is feasible and achieves successful result in patients undergoing hepatorenal transplantation. Recently, we experienced one case of hepatorenal transplantation. After setting for operation, renal transplantation was done first, and then liver transplantation was also done successfully without any problems of volume overload, massive transfusion and severe electrolyte disturbance. Total required volume for transfusion was packed red cell 9 units, FFP 4 units and crystalloid solution 8,600 ml. Patient was carried to the ICU after 16 hours operation, followed by the extubation 16 hours later in ICU and sent to the ward after 7 days ICU stay.