*Purpose: The use of flow probes to measure hepatic inflow at the conclusion of vascular anastomoses in Donation after Circulatory Death (DCD) liver transplantation is not routine and its value not clearly defined.

*Methods: A single-institution retrospective review of DCD liver transplant case records from 2005-15 was conducted. Intraoperative vascular flow data (Portal vein and Hepatic artery) was collected prior to initiation of biliary anastomosis. These measurements were then compared against pertinent clinical variables and graft survival.

*Results: A total of 118 DCD transplants were performed during the study period. Median recipient age was 57 years, with male preponderance (71%). Hepatocellular carcinoma was the indication for transplantation in 36% cases. Mean follow up was 4.4 years. Four patients (3.4%) developed primary non-function, and intraoperative portal vein flow was found to be significantly less in these instances (p= 0.002). Graft loss was observed in 11 patients (9%). The rates of ischemic cholangiopathy, bile leak and anastomotic biliary stricture were 4.2%, 2.5% and 30% respectively. Flow data was available in 107 cases. Median (inter-quartile range) values/100gms liver tissue/min for total hepatic inflow, portal vein flow and hepatic artery flow were 107 (84-138), 93(64-122) and 14(10-23) mls respectively. Poor correlation of flow rates with peak liver enzyme activity was observed. Anastomotic biliary stricture was however associated with significantly lower total hepatic flow/100g/min and portal vein flow/100g/min (p= 0.011 and 0.004 respectively), but not with hepatic artery flow/100g/min. Portal vein flow <52.9mls/100gms/min was significantly associated with risk of graft loss (p=0.01).

*Conclusions: Measurement of intraoperative vascular inflow can provide prognostic information on biliary stricture potential and graft outcomes in DCD liver transplantation.

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