Biliary complication rates are reported to be between 15%-30% following liver transplantation, with biliary complication rates being more prevelent in pediatric patients (<18 years old). Biliary complication data from 21 pediatric patients who had liver transplants between September 2001 and June 2004 were retrospectively studied. The mean age of patients was 8.3 ± 5.05 years (range, 1-18 years). Sixteen patients (76.2%) were male and 5 were female (13.8%). Grafts had been donated from mothers (n = 10), fathers (n = 6), cadaver (n = 1), brother (n = 1), grandfather (n = 1), and uncles (n = 2). The left lobe was transplanted in 57.1% (n = 12), the left lateral segment in 33.3% (n = 7), and the right lobe in 9.6% (n = 2) of patients. Biliary reconstruction was accomplished via a duct-to-duct anastomosis in 12 (57.2%) patients and via a Roux-en-Y hepaticojejunostomy in 9 (42.8%). A biliary stent traversing through the anastomosis was placed during the operation and removed at the end of the third postoperative week after a control cholangiography. Postoperative biliary complications were encountered in 8 (38.1%) patients. Of these, 1 patient (4.7%) had anastomotic stenosis and 7 (33.3%) had biliary leakage. Four of the biliary leaks were from the duct-to-duct anastomoses. One patient also had hepatic arterial stenosis. All of the patients with biliary leakage were treated with percutaneous drainage catheters. An endoluminal biliary stent was placed in one patient percutaneously. Mean follow-up time was 10.2 ± 9.6 (range, 1-26) months. Three patients died during follow-up. Mortality due to biliary complications was not encountered. Interventional radiologic measures including cholangiography are highly effective in the treatment of biliary complications, even in the face of heavily disrupted anastomoses. In cases of biliary complication, percutaneous drainage, combined with internal drainage, may prevent biliary sepsis and provide long-term patency.