The deficiency of organ donors remains a barrier in kidney transplantation. Living donor kidney transplantation (LDKT) can overcome graft shortage, showing better outcomes. Many efforts are being made to expand the donor pool, such as hepatitis B surface antigen (HBsAg) positive donors to negative recipients, and anatomically-complicated donor kidneys with size discrepancy. We report our case in which we overcame various problems in LDKT. The recipient was a 56-year-old male, 106 kg, HBsAg negative with chronic renal failure due to diabetic nephropathy. The donor was the recipient’s spouse, a 63-year-old female, 56 kg (absolute weight difference was 50 kg; D