*Purpose: The definition for donors at “increased risk” for human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HCV) was updated in 2013 from the previous 1994 definition of “high risk” donors. These changes broadened the definition of donor risk to include incident in addition to prevalent disease. We studied the impact of the changed definition on lung transplant recipient outcomes of acute rejection, graft and patient survival.

*Methods: Subjects undergoing lung transplant between 1/1/2006-5/31/2017 were identified from the Scientific Registry of Transplant Recipients and divided into 2 cohorts: 1) high risk donors (HRD): 1/1/2006-10/1/2013 and 2) increased risk donors (IRD): 2/1/2014-5/31/2017 and compared to standard risk donors (SRD). Recipient and donor variables were analyzed using analysis of variance, Kruskal-Wallis, and Pearson’s chi-square tests. Logistic regression was used to estimate a propensity score for donor status and IRD/HRD were matched to SRD using a greedy matching algorithm. Rejection within 1 year was evaluated with conditional logistic regression and patient and graft survival were evaluated with Cox regression.

*Results: 18,490 subjects were analyzed with 36% transplanted during the period of IRD definition. The proportion of donors meeting IRD criteria was higher compared to HRD (22% vs. 8%, p < 0.001). In both IRD and HRD cohorts, males with a lower forced expiratory volume in 1 second (FEV₁) and higher creatinine were more likely to receive an organ from donor with increased risk. Neither graft nor patient survival differed by donor type in either period. Interaction terms confirmed that the change in definition did not impact graft or patient survival. Acute treated rejection within 1 year differed by period with recipients of HRD experiencing increased odds (OR 1.2, p=0.27), and recipients of IRD experiencing decreased odds (OR 0.87, p=0.23) with a marginally significant interaction term (p=0.05) suggesting a change in association between definitions.

*Conclusions: Broader definition of donor risk increased the proportion of donors characterized as IRD compared to the previous definition of HRD. Utilization of HRD and IRD differed by recipient gender and measures of illness. However, use of donors defined as HRD or IRD did not adversely impact graft or patient survival.

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