Biliary cast syndrome (BCS) is an unusual complication of liver transplantation (LT). The pathophysiology is not known, and it is thought to develop because of mucosal damage in the bile duct related to obstruction, ischemia, or bacterial infection. It occurs in 2.5-18% of LT patients and is associated with increased graft failure, need for retransplantation, and mortality. Here we report on a case of BCS of late appearance after LT who was successfully treated by endoscopic means.