Background: Hypatremic donors was regarded as the expanded criteria donors in liver transplantation. The study was to investigate the effects of donor hypatremia on the outcomes of liver transplantation and identify the prognostic factors possibly contributing to the poor outcomes.Methods: Donor serum sodium levels before procurement were categorized as normal sodium ( < 155 mmol/L), moderate high sodium (155–170 mmol/L), and severe high sodium ( ≥ 170 mmol/L). Fur- thermore, we subdivided the 142 hypatremic donors ( ≥ 155 mmol/L) into two subgroups: subgroup A, the exposure time of liver grafts from hypatremia to reperfusion was < 36 h; and subgroup B, the exposure time was ≥ 36 h. The outcomes included initial graft function, survival rates of grafts and recipients, graft loss and early events within the first year following liver transplantation. Results: There were no significant differences in the 1-year survival rates of grafts and recipients, 1-year graft loss rates and early events among the normal, moderate high and severe high sodium groups. How- ever, the overall survival rates of grafts and recipients in subgroup A were significantly higher than those in subgroup B. Cox model showed that the exposure time (HR = 1.117; 95％ CI: 1.053–1.186; P < 0.001), cold ischemia time (HR = 1.015; 95％ CI: 1.006–1.024; P = 0.001) and MELD (HR = 1.061; 95％ CI: 1.003–1.121; P = 0.037) were the important prognostic factors contributing to the poor outcomes of recipients with hypatremic donors. Conclusions: The level of donor sodium immediately before organ procurement does not have negative effects on the early outcomes following adult liver transplantation. For hypatremia liver donors, min- imization of the exposure time from hypatremia to reperfusion is critical to prevent graft loss.