Use of the supraceliac aorta for hepatic arterial reconstruction of the transplanted liver in the setting of inadequate recipient celiac and hepatic arterial inflow has been advocated and has resulted in a decreased hepatic artery thrombosis rate in both the adult and pediatric populations. Over the past 6 years, we have utilized the supraceliac aorta in more than 200 patients without complication. However, in this communication, we report a major neurologic complication that resulted in anterior spinal artery syndrome.