Two stage liver transplants have been described for ‘toxic liver syndrome’ and for shattering liver trauma. We herein report a cadaveric liver transplant where the grafting was completed in two stages – graft reperfusion in the first stage with a tube hepaticostomy, and a delayed biliary reconstruction. Case study: A 48 years diabetic male (BMI 32) with cryptogenic cirrhosis, refractory ascites, hepatorenal syndrome and a prior surgery, was taken up for cadaveric liver transplantation. The donor liver was healthy except for an unexplainable 15mm common bile duct. The recipient had 18 litres of ascites at surgery and a 3mm fibrotic bile duct, with grossly edematous stomach, duodenum and small bowel. After a piggy-back engraftment, the liver produced copious bile. A duct-to-duct biliary reconstruction was not feasible because of the size disparity and unhealthy native bile duct. Severe bowel edema precluded a safe bilio-enteric anastomosis. A 14 Fr T-tube was inserted into the graft CBD and the procedure completed as a tube hepaticostomy. Postoperatively he maintained his immunosuppression level well on bile refeeding. His ascites resolved in 80 days. On the 86th day post-engraftment, he underwent a Roux-en-Y hepaticojejunostomy, with uneventful recovery and discharge after two weeks. 90 months post-HJ, the patient remains healthy with a normal graft function. Delayed biliary reconstruction in such situation is novel, and the excellent longterm outcome prompts this report.