During the past 4 years, the authors performed catheter drainage in 15 patients (five adults and 10 children) with 16 hepatic allografts who had intrahepatic bilomas after occlusion of the hepatic artery. Ten of the 16 (62%) allografts (in four adults and six children) were replaced within 4 months of drainage: Nine were replaced because of biliary sepsis or abscess, and one was replaced because of the absence of biliary-enteric communication. Most of these patients had cholangiographic evidence of extensive bile duct necrosis. In two patients, retransplantation was avoided for longer than 2 years. One of these needed a new liver because of multiple central biliary strictures. Four patients have now lived for 30-44 months since initiation of drainage without needing new livers. Despite drainage, the outcome of most of these allografts has been poor. However, in some liver transplant recipients who have had hepatic artery thrombosis, biloma drainage can prolong allograft survival and prevent retransplantation.