Bile duct leaks and stenosis, although greatly reduced in their incidence, still play a major role in early and late graft loss. Their pathogenesis is multifactorial, being related to graft quality, ischemia time, arterial blood flow, and, of course, technical mishaps. The diagnosis and treatment of biliary complications is nowadays a joint effort among surgeons, interventional radiologists, and gastroenterologists. The correct algorithm in obtaining a fast diagnosis and the correct therapeutic approach are necessary to save the graft, avoid retransplantation or recipient death. Although this may seem to be a simple and basic concept, it assumes tremendous importance in liver transplantation in which the differential diagnosis between biliary and arterial complications or graft rejection and malfunctioning is often a difficult one.