*Purpose: Increasing the recovery and utilization of donor livers has become a key goal for transplant programs in the United States over the past decade. One of the key strategies has been to expand the donor pool by utilizing organs previously considered unacceptable. These include organs from designated U.S. Public Health Service increased risk donors (IRD) who are at risk of carrying undetectable, yet still infectious, levels of blood borne virus.

*Methods: Recipients of organs from IRD require regular screening for blood borne infection. We evaluated our own center’s compliance with our prescribed testing regimen. A prospectively maintained database was utilized to perform retrospective analysis on all recipients of liver transplants from IRD between January, 2010 and March, 2019. Hepatitis B virus surface antigen testing was scheduled at 1, 3 and 12 months post-transplant. Compliance, heretofore unstudied, was analyzed in an effort to optimize the safety of our continued utilization of IRD organs.

*Results: Our study period included 775 liver transplants, of which 145 were from high risk donors (19%). 31/145 (21%), 125/144 (87%) and 129/144 (90%) of liver recipients from IRD received their scheduled 1, 3 and 12 month HBV testing. No cases of HBV, HCV or HIV transmission were recorded in recipients of IRD livers.

*Conclusions: The number of IRD livers used at our center has risen and accounted for 45/121 (37%) of transplants from January, 2018 to March, 2019. This mirrors national trends. Cases of viral transmission from IRD confirm that routine screening of recipients is necessary. Surveys of transplant infectious disease physicians suggest compliance rates of less than 70% nationally. Our experience with successful infectious disease testing compliance in a large center with a robust IRD liver transplant program suggests that improved national compliance is possible.

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