We report a case of a woman in her early 50s evaluated as a living liver donor candidate for her husband. Recurrent mild elevations of alanine aminotransferase (ALT) levels prompted further investigation, and a percutaneous ultrasound-guided liver biopsy revealed unexpected and marked lipofuscin deposition within hepatocytes, without evidence of steatosis, inflammation, fibrosis, or cholestasis. Lipofuscin, an age-related pigment, is generally considered benign, with an unclear association with hepatic dysfunction. This evidence concerns the gene GPT and cholestasis.