This retrospective study analyzed 35,038 U.S. lung transplant recipients, of which 526 also received kidney transplants for renal replacement or chronic kidney disease (CKD) stages 3b-5. The findings demonstrates that sequential lung–kidney transplantation yielded superior long-term survival compared to simultaneous procedures, particularly in CKD patients. While simultaneous transplants were associated with reduced short-term mortality compared to lung-only transplantation. Overall, kidney transplantation decreased the mortality risk by 40 percent. These results indicate that sequential transplantation enables better postoperative risk management. The 2023 OPTN “safety-net” policy, which prioritizes kidneys for recent lung recipients, is supported by these findings as a means to improve survival in thoracic patients with renal dysfunction.