BACKGROUND The impact of hypertensive (HTN) donor grafts on the prognosis of simultaneous liver-kidney transplantation (SLKT) patient is not known, and an applicable risk scoring system for SLKT patient survival is lacking. This study aimed to evaluate the impact of donor HTN on patient survival of SLKT recipients and to identify independent risk factors. MATERIAL AND METHODS Data from 3844 adult SLKT recipients receiving deceased donor grafts from March 2002 to December 2014 in the Scientific Registry of Transplant Recipients (SRTR) database were retrospectively analyzed. Kaplan-Meier analysis was used to compare patient and graft survival. Multivariate Cox proportional hazard models were built to identify independent risk factors associated with patient and graft survival. RESULTS SLKT patients receiving HTN donor grafts had significantly shorter 5-year patient survival and kidney graft survival rates than did those receiving non-HTN donor grafts (50.1% vs. 63.2%, p<0.0001 and 45.4% vs. 67.8%, p<0.0001, respectively). Multivariate analysis identified HTN donor, donor age, donation after cardiac death, cold ischemia time, recipient age, recipient condition at transplant, recipient hepatitis C infection, need for life support, and recipient pre-transplant albumin level as independent risk factors associated with inferior patient survival in SLKT recipients. A risk scoring model that predicted excellent stratification of prognostic subgroups was established (AUC, 0.762; 95% CI, 0.739-0.785). CONCLUSIONS An SLKT patient receiving a graft from an HTN donor has an inferior prognosis. A risk scoring system applicable to patient survival in SLKT recipients was developed.