Abstract
Background: Biliary complications are the most common postoperative adverse events after living donor liver transplantation, largely determined by variations in biliary anatomy. Materials and Methods: A retrospective analysis of 208 adult living donor liver transplantation recipients (2011–2024). Clinical, perioperative, and anatomical variables, including Modified Huang bile duct types, were evaluated. Early (≤3 months) and late (>3 months) complications were compared. Results: Biliary complications occurred in 24.5% of recipients. Type C anatomy showed the highest risk (56.5%, p = 0.0140). Prolonged cold ischemia time was strongly associated with biliary complications (p = 0.0001). Early biliary complications were mainly bile leaks, while late biliary complications were predominantly strictures requiring more interventions. Overall survival was 91.8% at 1 year and 72.1% at 10 years. Conclusion: Biliary complications after living donor liver transplantation are primarily determined by biliary anatomical variation. Type C ducts significantly increase the risk of postoperative complications. Early identification of high-risk anatomy and individualized surgical planning may reduce biliary morbidity. Keywords: living donor liver transplantation; biliary complications; bile duct anatomy; Huang classification; bile leak; biliary stricture.