*Purpose: Two surgical techniques are currently used for biliary reconstruction and each has its advantages/disadvantages. However, it is unclear if the used technique can impact patient and graft survival.

*Methods: This was a retrospective analysis comparing adult liver transplantation with hepaticojejunostomy versus duct to duct anastomosis in the period between January 2011 and December 2017. We excluded simultaneous liver/kidney, partial graft either living donor or split liver, intraoperative deaths, 30-day mortality cases and cholangiocarcinoma cases.

*Results: 510 cases were studied, DD group included 472 and HJ group included 38 cases. Median age for HJ group was 57 (23-70) year versus 59 (21-73) year for DD group (P=0.319). 28.9 % were female in HJ group versus 37.3 % in DD group (P = 0.305). 10.5% were African American in HJ group versus 13.2 % in DD group (P = 0.728). The 1-, 3-, and 5-year patient survival for HJ group was 97%, 97%, and 97% versus 90%, 86%, and 77% for DD group (P = 0.037). The 1-, 3-, and 5-year graft survival for HJ group was 94%, 94%, and 94% versus 89%, 84%, and 75% for DD group (P = 0.072). Postoperative biliary complications (17.2% in HJ group vs. 33.6 % in the DD group, P = 0.068). No significant differences between both groups regarding DM, HTN, CAD. H-J was an independent predictor of patient survival in multivariate analysis (P=0.049).

*Conclusions: HJ for biliary reconstruction in liver transplantation is associated with significantly better patient survival with tendency for better graft survival. Postoperative biliary complications tended to be higher in DD group. These findings need to be replicated in multicenter study.

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