*Purpose: Hepatic Artery Thrombosis (HAT) is an uncommon complication after liver transplant, but its occurrence can lead to significant and fatal outcomes. Our objective was to identify potential donor, recipient, and perioperative factors associated with the development of HAT.

*Methods: We conducted a single-center retrospective cohort study of consecutive adult deceased donor liver transplants from January 2013 through April 2019.

*Results: The results of 479 liver transplants were analyzed. Twenty-five (5.2%) patients developed HAT. African American (19%) and Hispanic (14%) liver transplant recipients had significantly more HAT compared with Caucasians (3%), p<0.001. Patients with low donor/recipient body surface area index had significantly more HAT (0.90 + 0.13 vs 0.96 + 0.13, p = 0.017). Post-op ultrasounds within the first 24 hours demonstrated significantly lower arterial flow rates (m/sec) in the common, right and left hepatic arteries (96.2 + 58.7 vs 126.4 + 90.9, p = 0.024; 49.5 + 27.4 vs 72.2 + 44.6, p = 0.001; 35.7 + 24.3 vs 60.0 + 38.0, p < 0.001) of patients with HAT. Kaplan-Meier analysis confirmed that HAT lead to reduction in graft and patient survival (2,103 vs 1,484 days, p < 0.001; 1,996 vs 1,626 days, p = 0.007).

*Conclusions: Adult liver transplant patients with hepatic artery thrombosis have worse graft and patient survival compared to those without HAT. Further exploration of underlying recipient diagnoses and comorbidities, and the degree of shunt or portal hypertension are indicated.

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