Recent studies have suggested a relationship between intra-arterial therapy and the development of HAS following orthotopic liver transplant (OLT). This study evaluates the role of pretransplant locoregional therapies on post-OLT HAS. An IRB-approved, multicenter, retrospective analysis was performed on all patients who underwent liver transplant from January 2, 2016, to December 30, 2018 (n = 608). Patients undergoing locoregional therapy were identified, which was determined based on consensus review of a multidisciplinary liver conference for patients with hepatocellular carcinoma (HCC) and included DEB-TACE (100-300μ LC Beads mixed with doxorubicin), Yttrium radioembolization segmentectomy (TheraSphere), and thermal ablation. Additional treatments were performed as deemed necessary, based on incomplete response, with the majority of patients (n = 96) receiving 1-2 treatments. Patients were surveyed with doppler ultrasound at 1 day, 1 week, 1 month, and 3 months following orthotopic liver transplant (OLT). HAS was suspected based on findings of elevated hepatic artery velocity with downstream intrahepatic artery tardus parvus waveforms and low resistive indices and confirmed angiographically in all patients. Of the 608 patients who were transplanted during the 3-year cohort, 145 patients had HCC, and intra-arterial bridging therapy was performed on 126 patients (115 TACE, 5 Y90, and 6 TACE and Y90). Following OLT, 78 patients (13%) developed HAS. Fewer rates of HAS were noted in patients with HCC (12/145 [8.3%] vs. 66/463 [14.3%], P = 0.05). Similarly, fewer rates of HAS were encountered in patients bridged with intra-arterial therapy (10/126 [8%] vs. 68/482 [14.1%], P = 0.06). Additionally, patients who were treated with thermal ablation prior to liver transplant also had lower rates of HAS (1/24 [4%] vs. 77/584 [13%], P = 0.03). However, MELD scores at the time of liver transplant were associated with the development of HAS (P = 0.001). Intra-arterial therapy is not associated with the development of HAS following OLT; however, underlying liver disease appears to be associated with the development of HAS.