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Reconstruction of biliary drainage after liver transplantation (LTx) in patients with primary sclerosing cholangitis (PSC) has been a matter of controversy. Over the recent years, the traditional method of Roux-en-Y hepaticojejunostomy (RY) has been challenged by duct-to-duct (DD) biliary reconstruction. The argument against DD reconstruction has been for potential increased risk of development of cholangiocarcinoma (CCA) in the bile duct remnant.This is a retrospective review of biliary complications, graft and patient survival after LTx in PSC patients based on type of biliary reconstruction DD vs. RY.A total of 120 LTx for PSC were performed between 2005 and 2016. Twenty two patients were excluded because they received partial grafts. DD was done in 39 patients and 59 patients were reconstructed with RY. One-, 5-, and 10-year survival was similar between the two groups.Bile leak and biliary stricture was not significantly different between the 2 groups. Nine patients in DD group (23%), and 13 patients in RY group developed biliary strictures and all managed endoscopically or percutaneously. There was one case of anastomotic leak in each group. There was no case of CCA observed in these patients over the long period of follow-up.DD biliary reconstruction at the time of LTx in selected PSC patients is both effective and safe, with comparable outcomes with those with RY reconstruction and NO increased risk for development of CCA in the bile duct remnant.