Successful management of portal vein (PV) complications after liver transplantation is crucial to long-term success. Little information is available, however, regarding the incidence and treatment of PV complications after adult-to-adult living donor liver transplantation (LDLT). Between January 1996 and October 2006, 310 adult LDLTs were performed at our institution. PV thrombus was present in 54 patients at the time of LDLT. The incidence of PV complications, choice of therapeutic intervention, and outcomes were retrospectively analyzed. Among the 310 recipients, PV complications were identified in 28 (9%). Risk factors included smaller graft size, presence of PV thrombus at the time of LDLT, and use of jump or interposition cryo-preserved vein grafts for PV reconstruction. When divided into early (within 3 months,n= 11) and late (after 3 months,n= 17) complications, the use of vein grafts for PV reconstruction predisposed to the occurrence of late, but not early, PV complications. Portal vein thrombosis occurred more frequently in the early period (eight out of 11, 73%), whereas stenosis occurred more frequently in the later period (14 out of 17, 82%). Surgical interventions were favored in the earlier period, whereas interventional radiologic approaches were selected for later events. Overall 3- and 5-year survival rates were 81% and 77%, respectively, in patients with PV complications and 88% and 84%, respectively, in those without PV complications (P= 0.21, log-rank test). PV complications are a significant problem following LDLT with both early and late manifestations. Acceptable long-term results, however, are achievable with periodic ultrasonographic surveillance and timely conventional therapeutic interventions. The use of cryo-preserved vein grafts for reconstructing portal flow should be discouraged.