Acute (AR) and Chronic (CR) rejection cause considerable morbidity and mortality following transplantation. This study explores the associations of biopsy proven AR in lung (LTx) and kidney (KTx) transplants recipients from the one donor. Material/Methods: Between 2001 and 2006, 136 multiorgan donors contributed 144 LTx and 261 matching KTx. Utilizing LTx records and the Australian and New Zealand Dialysis and Transplant Registry, this study analyses the incidence and associations of LTx and KTx AR. Results: AR was noted in 49 of LTx [median of 17 (11-347) days] and 29 of KTx [median of 22 (1-1044) days]. Following univariate and multivariate analyses: 1) LTx AR was not associated with PGD in either LTx or KTX, nor with AR in KTx recipients, but was associated with donor PaO2/FiO2 ratio, type of LTx, CMV bronchoalveolar lavage load and extent of HLA mismatching; 2) KTx AR was not associated with PGD, but was associated with AR in the paired kidney, HLA DR mismatching and HLA A matching. Conclusions: AR in LTx and KTx recipients from the same donor are not associated. AR and PGD do not appear linked in either organ. KTx (and not LTx) AR was associated with CRrelated graft loss.