*Purpose: Biliary complications in the post HCV era has not been well defined.

*Methods: We retrospective studied 209 patients transplanted from April 2015 to November 2019 at a single institution. We reviewed patient and graft demographics including age, cold ischemia, etiology of disease, biliary reconstruction. We analyzed the outcomes of recipients for biliary leak, stricture, and resolution with endoscopic treatment or requirement for biliary reconstruction.

*Results: The one-year biliary complication rate for patients transplanted from April 2015 to November 2019 was 20% (42/209). Of the 42 patients with biliary complication, 39 (75%) had biliary stricture, 12 (23%) had biliary leak, and 1 (2%) had ischemic cholangiopathy. The majority of patients were treated with biliary stents using endoscopic retrograde cholangio-pancreatography, with a medium number of 2 ERCPs. Nine (4%) of the patients required surgical biliary revision.

*Conclusions: Conclusions: When compared to a metanalysis of 45 papers from 2008-2015, our biliary complication rate was similar to the reported annual biliary complication; 20% vs 23% respectively. Additionally, our data did not show a difference in overall survival between patients with biliary complications vs those without biliary complications in the first year post transplant. Biliary complications do not appear to have reduced in a post HCV era.

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