Background Donation after circulatory death (DCD) liver transplant helps expand the donor pool but remains limited by conservative acceptance criteria due to high rates of ischemic complications such as non-anastomotic biliary strictures. This study aimed to document the experience of an Australian liver transplant center comparing the outcomes of transplants conducted using DCD grafts preserved with back-to-base normothermic machine perfusion (NMP) and standard cold storage (SCS). Methods A retrospective cohort study was assessing DCD liver transplant outcomes performed between 2015 and 2024 with grafts preserved using NMP (n=37) or SCS (n=26). The primary outcome was non-anastomotic biliary stricture development and secondary outcomes included traditional liver transplant outcomes such as graft and patient mortality, complications, and early allograft dysfunction (EAD). Results There was no statistically significant difference in the development of clinically significant NAS requiring intervention (NASc) or radiological NAS (NASr) between NMP and SCS (NASc: 8.1% vs 23.1%; p=0.192; NASr: 24.3% vs 30.8%; p=0.780). The NMP group had higher donor risk index (2.2 vs 1.8, p=0.014) and model for end-stage liver disease scores (19.9 vs 13.6; p=0.029) and developed less EAD relative to the SCS group (13.5% vs 73.1%, p<0.001). Longer cold ischemia time was associated with odds of developing NASc (multivariate OR [95% CI]: 1.02 [1.00–1.03]; p=0.034). There were no differences in patient and graft survival, complications, retransplantation, or length of stay between preservation groups. Conclusion NMP use facilitates high-risk DCD transplant, despite a higher risk donor and recipient cohort there was no compromise in biliary outcomes and EAD relative to the SCS group. Further research directed towards on-pump viability assessment and efforts to minimize ischemic time will likely improve graft selection and outcomes as the extended criteria transplant practice expands.