Tolerance induction through simultaneous hematopoietic stem cell and renal transplantation has shown promising results, but it is hampered by the toxicity of preconditioning therapies and graftversushost disease (GVHD). Moreover, renal function has never been compared to conventionally transplanted patients, thus, whether donorspecific tolerance results in improved outcomes remains unanswered. We collected followup data of published cases of renal transplantations after hematopoietic stem cell transplantation from the same donor and compared patient and transplant kidney survival as well as function with calipermatched livingdonor renal transplantations from the Austrian dialysis and transplant registry. Overall, 22 tolerant and 20 control patients were included (median observation period 10 years [range 11 months to 26 years]). In the tolerant group, no renal allograft loss was reported, whereas 3 were lost in the control group. Median creatinine levels were 85 mol/l (interquartile range [IQR] 7299) in the tolerant cohort and 118 mol/l (IQR 99143) in the control group. Mixed linearmodel showed around 29% lower average creatinine levels throughout followup in the tolerant group (P < .01). Our data clearly show stable renal graft function without longterm immunosuppression for many years, suggesting permanent donorspecific tolerance. Thus sequential transplantation might be an alternative approach for future studies targeting tolerance induction in renal allograft recipients.