Kaposi sarcoma following solid organ transplantation is a rare and underreported complication, with few cases documented globally concerning its origin from liver grafts.This case report describes an Asian woman who developed Kaposi sarcoma in a liver graft following living donor liver transplantation for end-stage liver disease resulting from hepatitis D virus. In accordance with current guidelines, standard immunosuppression was discontinued, and mammalian target of rapamycin (mTOR) inhibitors were initiated. The use of mTOR inhibitors led to the complete resolution of the liver graft lesions within 9 months. However, subsequent follow-up revealed several complications, including late anastomotic biliary stricture, extensively drug-resistant Klebsiella pneumoniae infection, and subtotal hydrothorax. These complications required intensive care unit admission, biliary stenting, oxygen therapy, and pleural drainage. Despite the severity of her condition, the patient fully recovered and showed no signs of recurrence throughout the 64-month follow-up period. To our knowledge, this is the first reported case of Kaposi sarcoma in a liver graft with such an extended follow-up.