The number of critically ill patients undergoing orthotopic liver transplantation (OLT) has constantly increased since the introduction of the MELD system in 2006. In many cases patients with a high MELD score (> 30 MELD points) show an impaired renal function reflected by an increase in serum creatinine levels or a decrease of the glomerular filtration rate (GFR). It has been suggested that immunsuppression with mTor-inhibitors might improve renal function in patients after OLT. In 84 patients with a lab MELD score > 30 OLT was performed after MELD based allocation was introduced. In 15 patients (18%) immunosuppression was converted from calcineurin inhibitor based immunosuppression to Everolimus. Initial analysis of these 15 patients showed no significant differences in serum creatinine levels or MDRD (Modifikation of Diet in Renal Disease)-GFR within 270 days after conversion of the immunosuppressive protocol compared to values before conversion. Ten out of these 15 patients (66%) showed a creatinine greater 100 umol/l at the day of conversion (mean 201.2 ± 72.3 umol/l). Renal function improved significantly with creatinine 201.2 ± 72.3 umol/l before vs. 138 ± 32.7 (p=0.03) at day 90 (± 45, n=9) after conversion in this group. Regarding GFR an increase could also be shown with mean GFR of 37.1 ml/min/1.73m2 at day of conversion vs. 53.4 ± 19.3 ml/min/1.73m2 (p=0.02) at day 90. This effect remained significant for creatinine levels over the analyzed period of 270 days. Our data support the previously published positive effect of everolimus on renal function post transplantation. This effect could only be shown in patients with an already impaired renal function (creatinine >100 umol/l, GFR < 100 ml/min/1.73m2) at day of conversion. For high MELD patients with an impaired renal function in conversion from CNI to everolimus based immunosuppressive protocols seems to be justified, however further studies including more patients and longer follow up periods are necessary.