PURPOSEBiliary complications develop at a higher rate in living donor liver transplantation (LDLT) compared with cadaveric liver transplantation. Almost all studies about biliary complications afterLDLT were made with the right lobe. The aim of this study was to determine the frequency ofbiliary complications developing after adult left lobe LDLT and to evaluate the efficacy of the algorithm followed in diagnosis and treatment, particularly percutaneous radiological treatment.METHODSA total of 2185 LDLT operations performed in our center between May 2009 and December 2019 were retrospectively reviewed and patients receiving left lobe LDLT were analyzedregarding biliary complications and treatments. Biliary complications were treated via percutaneous drainage under ultrasound (US) guidance, endoscopic retrograde cholangiopancreatography (ERCP), and percutaneous transhepatic cholangiography (PTC)/ percutaneoustranshepatic biliary drainage (PTBD). Patient demographics, ERCP procedures before percutaneous treatment, and percutaneous treatment indications were analyzed.RESULTSA total of 69 adult patients received left lobe LDLT. Biliary complications requiring endoscopicand/or percutaneous treatment developed in 28 patients (40%). Of these patients, 4 had bileleakage (14%), 20 had anastomosis stricture (72%), and 4 had both leakage and anastomosisstricture (14%). External drainage treatment under ultrasound guidance was sufficient for 2 of4 patients with bile leakage, and these cases were accepted as minor bile leakage (7%). Overall, 26 patients underwent ERCP; of these, 8 were referred for PTC/PTBD because the guidewire and/or balloon-stent could not pass the anastomosis stricture (n=7) and common bileduct cannulation could not be obtained because of duodenal diverticulum (n=1). DiagnosticPTC was performed in 10 patients, 8 were referred after inadequate/failed ERCP procedureand two were referred directly without ERCP. Anastomosis stricture was found in 7 patientsand anastomosis stricture and bile leakage in 3. In 7 patients determined to have stricture,balloon dilatation was applied and then biliary drainage was performed. In 3 patients whohad leakage and anastomosis stricture, balloon dilatation was applied for stricture; after dilatation, an IEBD catheter was placed through the leakage region in 2 patients, while a coveredmetallic stent passing through the leakage region was placed in one patient.CONCLUSIONGenerally, ERCP is the first preferred method in biliary complications of LDLT; however, incases where a response cannot be obtained by endoscopic treatment or require complexand/or aggressive treatment, percutaneous radiological treatment should be the treatmentof choice before surgery in left lobe LDLT.