扩大标准供肝（ECD）的使用是广受争议的，尤其是对于再次移植的患者。该研究的目的在于明确ECD供体再次移植的效果并根据先前已存在的供者危险指数来制定关于再次肝移植有预测价值的死亡指数。我们分析了UNOS从2002年2月进行再次肝移植的数据。所有的供者根据ECD的不同特性分类，并采用再次移植供者危险指数（ReTxDRI）的多元生存模型。我们共分析了1327例患者。共有611（46％）名受者接受了至少一项指标的ECD供体。HCV阳性的受者使用ECD的供体后生存率无明显影响。供者危险指数对于受者移植物失功的额外原因构成了ReTxDRI。在多元受体因素调整后，ReTxDRI对于所有受者的生存率有预测意义，且是再次移植后死亡的强独立预测因素（HR 2.49, 95% CI 1.89-3.27, p < 0.0001）。ReTxDRI的使用能够提高供受匹配的几率，并能够提高再次肝移植后患者的生存率。

The use of extended criteria liver donors (ECD) is controversial, especially in the setting of retransplantation. The aims of this study are to investigate the effects of ECD grafts on retransplantation and to develop a predictive mortality index in liver retransplantation based on the previously established donor risk index. The United Network for Organ Sharing (UNOS) liver transplant dataset was analyzed for all adult, non-status 1, liver retransplantations occurring in the United States since February 2002. All donors were categorized for multiple characteristics of ECD, and using multivariate survival models a retransplant donor risk index (ReTxDRI) was developed. A total of 1327 retransplants were analyzed. There were 611 (46%) recipients who received livers with at least one ECD criterion. The use of ECD grafts in recipients with HCV did not incur worse survival than the non-ECD grafts. The addition of the cause of recipient graft failure to the donor risk index formed the ReTxDRI. After adjusting for multiple recipient factors, the ReTxDRI was predictive of overall recipient survival and was a strongly independent predictor of death after retransplantation (HR 2.49, 95% CI 1.89-3.27, p < 0.0001). The use of the ReTxDRI can improve recipient and donor matching and help to optimize posttransplant survival in liver retransplantation.

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