The incidence of biliary complications (BC) after living donor liver transplantation (LDLT) can reach 40%. Published data on the pediatric population is limited and treatment protocols vary. Our aim is to describe the clinical scenario and treatment approaches in BC after LDLT. Between October 1995 and December 2012, 489 pediatric LDLT were performed. BC developed in 71 patients (14.5%). Biliary strictures (BS) developed in 45 (9.2%) patients and bile leaks (BL) in 33 (6.7%). Diagnosis of BL was clinical in all cases and 69.6% of patients underwent surgery. Of the BS cases, nearly half had clinical features or suggestive US findings. Liver biopsy suggested BS in 51.7%. Percutaneous transhepatic cholangiography (PTC) was performed in 95.5% of the BS patients. Success-rate was of 77% (mean of 3.9 ± 1.98 percutaneous biliary interventions (PBI) and median drainage time of 8 months). In conclusion, BL patients can be managed with conservative therapy, even though most of the patients are ultimately treated with surgery. Diagnosing BS requires a high degree of clinical suspicion because the available resources for its identification can fail in up to 50% of the cases. A higher number of PBI and a longer permanence of the drainage catheter may be required to achieve better results with this technique. Liver Transpl , 2014. © 2014 AASLD.