Purpose: Atrial fibrillation is the most common cardiac arrhythmia and a harbinger of major complications. It adversely affects cardiovascular morbidity and mortality and escalates risk for stroke. Organ transplants are scarce and effective allocation for suitable recipients is paramount. The impact of preexisting atrial fibrillation in patients undergoing liver transplantation has not yet been characterized. Methods: Patients who underwent liver transplantation between Jan 2005 and Dec 2008 were identified, and all patients with preexisting atrial fibrillation were identified by chart review. Each patient was matched to 2 controls according to recipient age, raw Model for End Stage Liver Disease score, Donor Risk Index and pre-transplant diabetes status. Survival analysis was performed using Kaplan-Meier curves and the log rank test. Results: 717 patients underwent liver transplantation during the study period. Of these, 32 patients had pre-existing paroxysmal, recurrent or chronic atrial fibrillation, and were matched with 64 controls from the same cohort. Mean graft survival was 1243 days (SD, 881) in the group with atrial fibrillation and 1444 days (SD, 889) in the matched controls (p=0.136). Mean patient survival was 1400 days (SD, 849) versus 1446 days (SD, 886) in the atrial fibrillation and control groups respectively (p=0.444). Compared to controls, persons with atrial fibrillation were more likely to have a cardiac cause of death (p=0.041; OR, 3.287), perioperative cardiac events (p=0.02; OR, 7.826), history of stroke (p=0.036; OR, 3.509), left ventricular hypertrophy (p=0.023; OR, 3.143), greater degree of mitral valve regurgitation (p=0.028; OR, 1.732) and history of congestive heart failure (p=0.043; OR, 8.857). These applied regardless of whether the atrial fibrillation was paroxysmal, recurrent or chronic-persistent. Conclusion: Liver transplant patients with pre-existing atrial fibrillation are more likely to develop perioperative cardiac events and have a higher cardiovascular morbidity and mortality than their matched controls, regardless of the type of atrial fibrillation. These results have potential implications for the management of this patient population.