Experiences With Expanded Criteria Donors: 10-Year Analysis of the Martin, Slovakia Transplant Center.

OBJECTIVES: Kidneys from expanded criteria donors with diagnosis of brain death have become a part of the organ transplant program, which have thus increased the number of transplants. MATERIALS AND METHODS: In this retrospective analysis, we identified the expanded criteria donors in a group of 156 kidney donors at our center. Basic parameters of the donors before kidney recovery were collected. Graft function, graft survival, and patient survival at 1, 3, and 5 years posttransplant were compared in expanded criteria versus standard criteria donors. RESULTS: Expanded criteria donors were significantly older than standard criteria donors (P < .001), had higher body mass index (P = .006), and had more frequent arterial hypertension (P < .001) and diabetes mellitus (P = .004) in their histories. When we considered the estimated glomerular filtration rate, graft function in the first 6 months after transplant was significantly worse in kidneys from expanded criteria donors (P = .011). In addition, recipients of grafts from expanded criteria donors had significantly worse survival in the first year posttransplant (P = .023); however, no differences in graft survival were observed. CONCLUSIONS: From the long-term aspect, graft function and graft and patient survival in cases of kidneys from expanded criteria donors were comparable to results with kidneys from standard criteria donors. Expanded use of organs available for transplant is important due to the constantly increasing demands versus limited offers of organs.

Some quantitative EEG features in default mode resting state network under general anaesthesia.

OBJECTIVES: The default mode resting state network (DMRSN) constitutes a circuit which is active in conditions when the subject is at rest. We tested the hypothesis that its function will be altered during unconsciousness. METHODS: Changes in the mean squared coherences in five conventional frequency bands (delta to gamma) in DMRSN during general anaesthesia (GA) were investigated in 39 patients. They were compared with the normal EEG of 86 alert subjects, severely abnormal EEG of 112 patients with dementia and/or encephalopathy, and the mathematical model of brain death. RESULTS: Anaesthetised patients showed significant decrease in the gamma coherence in the posterior area of the DMRSN compared to both the control group and the patients with dementia and/or encephalopathy. Among the anaesthetized patients 21 had a clear burst suppression pattern with prolonged epochs of suppression in EEG. In suppressed EEG segment the differences between the connections of the anterior to posterior parts and connections between the posterior parts of the DMRSN were almost lost. However, they still showed highly significant differences in most items when compared with coherences in the mathematical model of brain death. CONCLUSION: The functional connectivity in the DMRSN could be a reliable and robust method for assessing the depth of anaesthesia and maybe also disorders of consciousness in general. The mean squared coherences in the gamma frequency band indicated the highest sensitivity for the depth of unconsciousness. The measure is not dependent on the diffused slowing in dementia or encephalopathy patients as long as they remain in a full consciousness.