Arterial steal syndrome (ASS) after orthotopic liver transplantation is characterized by arterial hypoperfusion of graft caused by a shifting of blood flow into splenic, left gastric, or gastroduodenal artery. In this report, we present some aspects of ASS that have led to ischemia in patients with transplanted livers at our center. ASS is suspected by elevated liver enzyme levels demonstrated on Doppler ultrasound or computed tomographic angiography, and is confirmed by celiac angiogram. Patients with confirmed hepatic arterial thrmbosis before angiography were excluded. Patients with ASS were treated with embolization with a coil or placement of an endoluminal stent. Of 11 liver transplant patients at our institution, 8 men and 3 women (mean age, 25 years age; range, 6-40 years) developed biochemical evidence of liver ischemia and failure 1 to 170 days after orthotopic liver transplantation. Ten of those patients had splenic ASS, and 1 had both splenic and left gastric ASS. None of those patients had gastroduodenal artery steal syndrome. The 9 patients with splenic steal syndrome and the 1 with both splenic and left gastric steal syndrome were treated by transcatheter occlusion with a coil. The remaining patient with splenic steal syndrome was treated with an endoluminal narrowing stent placement. All patients improved clinically within 24 hours. Follow-up ranged from 1 to 22 months (mean, 7.7 months). One patient died. In conclusion, ASS is a significant problem following orthotopic liver transplantation. Embolization or stenting are minimally invasive,successful treatments for ASS that generally result in early clinical improvement.