The following is a case report of a primiparous woman who developed fulminant liver failure in the setting of HELLP syndrome complicated by hepatic rupture. It is unique in that a timely ABO compatible liver donor was unavailable, necessitating the transplantation of an ABO incompatible organ. Despite aggressive therapy, severe reperfusion injury and humoral rejection dictated retransplantation with an ABO compatible organ on postoperative day 15, resulting in rapid clinical recovery.