*Purpose: Livers harvested from donors after cardiac death (DCD) are subjected to a period of relative warm ischemia during the agonal phase. There have been no large-scale studies correlating donor hemodynamics and oxygen saturation time-series data during the agonal phase with post-transplant graft outcomes.

*Methods: UNOS data was utilized to identify DCD liver donors and their respective recipients. Donor and recipient demographic and clinical data, as well as recipient follow-up data were also available. Donor hemodynamic time-series data collected in the operating room during the agonal phase was provided by UNOS. The time-averaged agonal phase oxygen saturation was calculated by integrating the oxygen saturation curve between withdrawal and cross-clamp, and dividing by the length of this period. Cox regression was utilized to investigate the effects of time-averaged oxygen saturation on hepatic graft failure. Standard recipient and donor clinical and demographic characteristics were also included in the model.

*Results: The hemodynamic profiles of 1967 DCD liver donors between 2013 and 2019 were analyzed. A mean of 11.5 data points were recorded for each patient during the agonal phase. Greater time-averaged oxygen saturation was found to be protective in terms of hepatic graft survival; each increase in average oxygen saturation by 5% was associated with a decrease in risk of graft failure by 3.3% (p = 0.030).

*Conclusions: Agonal phase oxygen saturation profiles in DCD liver donors appear to be correlated with post-transplantation hepatic graft survival. Improved understanding of agonal phase hemodynamic changes and the effect on long-term graft outcomes may help to inform organ selection and expand the donor pool.

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