Biliary complications continue to be a major cause of morbidity in liver transplant recipients with an incidence of 10–40% following liver transplantation and a mortality rate of up to 5%. Biliary leaks and strictures are the most common encountered complications. Biliary complications may be related to various factors such as hepatic artery patency, preservation injury, cytomegalovirus infection, chronic ductopenic rejection, ABO incompatibility, and technical reasons. The general management guidelines for biliary complications include conservative, endoscopic, percutaneous transhepatic and surgical approaches. Objectives; we sought to assess and to document the frequency, risk factors, clinical presentation, management and outcome of biliary complications after liver transplantation in patients who underwent LDLT in Wady El-Neel Hospital, Cairo, Egypt. From November 2001 to December 2008, 150 adult-to-adult living donor liver transplantations (LDLT) were undertaken using right lobe grafts (RLG). Patients were divided into those with and those without biliary complications. Duct-to-duct biliary anastomosis (DD) done in 98% of cases. The overall biliary complication occurred in 52 patients (34.7%), including bile stricture rate of 31.3% and bile leakage rate of 4%. Risk factors associated with biliary complications were prolonged cold ischemia time, multiple donor ducts together with multiple biliary anastomosis. Endoscopic interventions alone were successful in 38/50 patients (76%) and if combined with percutaneous methods (Rendezvous) the success rate becomes higher (96%). Overall patient survival rates at 1, 2, 3 and 4 years were 90.07%, 84%, 80% and 77.30% respectively. We concluded that post-liver transplantation biliary complications were relatively common and most biliary complications after LDLT can be successfully treated with nonsurgical approaches as both endoscopic and percutaneous methods had a satisfactory outcome. ERCP, in particular, has proven to be relatively safe and effective in the management of these complications. The occurrence of biliary complications does not appear to adversely affect the long-term graft and patient survival.