The number of deceased donor liver transplantations (DDLTs) in Japan is extremely small. There were 67 cases between February 1999 and January 2010, according to the Japan Organ Transplant Network [
1]. Therefore, living donor liver transplantation (LDLT) is the most frequent treatment option for patients with end-stage liver disease in Japan. The main advantage of LDLT over DDLT is that the donor can be completely evaluated, before the operation, to exclude many medical problems. However, the indications for a living donor should be strict and the risk to the donor must be avoided with the greatest care. Donors with possibly morbid liver conditions, including fatty infiltration or a history of viral hepatitis, and older donors offer "marginal grafts", which should be used only after very careful evaluation. A hepatitis B virus (HBV) core antibody seropositive donor can be accepted as long as HBV surface antigen is seronegative and anti-viral treatment is administered to the recipient after transplantation [
2,
3]. In this way, donor safety also is established, according to several reports of this type of case [
4‐
6]. Some investigators reported that the patients obtained a sustained viral response (SVR) after interferon therapy showed that there was no tendency to develop fibrotic liver in the future [
7,
8]. HCV-RNA was not detected in 88% of the serum and liver biopsies of patients with an SVR [
9]. The infection rate of the recipient from an HCV-positive graft should be low after LT. The rate of carcinogenesis has increased at an annual rate of 0.11% after an SVR was maintained with anti-viral therapy [
10]. Using a graft with a positive hepatitis C virus (HCV) antibody although HCV-RNA was not detected in the blood remains controversial in Western countries [
11‐
13]. To the best of our knowledge, there is no actual data that shows the outcome of liver transplantation with a graft from patients who acquire an SVR after successful anti-viral therapy. Here, we report the case of a living donor who had an SVR before LDLT. The case is described and discussed in detail.