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Ongoing refinement of microsurgical biliary reconstruction techniques has contributed to a significant decrease in early biliary complications after living donor liver transplant, according to findings published in the Journal of Liver Transplantation. The study team examined data from 2006 to 2022, comparing biliary complications within one year after transplant. Surgeons performed microsurgical biliary reconstruction using various refinements, including selective biliary stent insertion, a figure-of-8 suture over the junction of the graft and recipient bile ducts, and centralization techniques to address size discrepancies. In most cases (79.6%), surgeons performed duct-to-duct anastomosis. Investigators reported an overall rate of early biliary complications at 10%, noting significant improvements: the rate decreased from 10.35% between 2006 and 2021 to 6.5% by 2022. For a select set of patients, stent insertion, ipsilateral anastomosis, and the figure-of-8 suture technique led to a significant decline in early complications. The centralization technique showed promise, however it did not have a statistically significant effect.