Reversal of arterial oxygen desaturation with the use of an oxygen concentrator during injectable anaesthesia in feral cats positioned in the Trendelenburg, dorsal or lateral surgical position.

INTRODUCTION: This study observed the effects of oxygen supplementation, via an oxygen concentrator, on peripheral arterial blood oxygenation (SpO2) measured by pulse oximetry in anaesthetised cats undergoing spay in three different surgical positions. A total of 192 female feral cats were investigated for a large-scale trap-neuter-release program. Cats were anaesthetised with an intramuscular combination of butorphanol (0,4 mg / kg), ketamine (7-10 mg / kg) and medetomidine (0,03-0,05 mg / kg). Cats were randomly allocated to undergo spay in either Trendelenburg (TR) (70° downward head tilt), lateral (LR) or dorsal (DR) recumbency. Cats were breathing spontaneously either room air or 2 L/minute oxygen via a tight-fitting face mask. Pulse rate (in beats per minute), respiratory rate (in breaths per minute) and SpO2 (in percentage) were measured at baseline in left lateral recumbency and afterwards continuously after being positioned in allocated surgical position. At the end of surgery, cats were placed again in left recumbency, and all parameters were re-evaluated after five minutes. Overall, 33 % of cats showed severe arterial oxygen desaturation (SpO2 < 90 %) at baseline when breathing room air. When oxygen was supplemented during the procedure, arterial oxygen desaturation resolved in all cats. At the end of the procedure, 29 % of cats were hypoxaemic when oxygen was not supplemented, with an overall higher percentage of hypoxaemic cats in TR as compared to DR and LR recumbencies. All cats recovered well from surgery and were released within 24 hours post-anaesthesia. Arterial oxygen desaturation is frequent in cats anaesthetised with injectable anaesthesia for spay under field conditions. Oxygen supplementation administered via a tight-fitting mask resolved arterial oxygen desaturation in this feral cat population regardless of the surgical position and therefore oxygen supplementation is recommended in any case.

INTRODUCTION: Cette étude a observé les effets d'une supplémentation en oxygène, via un concentrateur d'oxygène, sur l'oxygénation du sang artériel périphérique (SpO2) mesurée par oxymétrie de pouls chez des chats anesthésiés subissant une stérilisation dans trois positions chirurgicales différentes. Au total, 192 chats sauvages femelles ont été examinés dans le cadre d'un programme de piégeage, de stérilisation et de remise en liberté à grande échelle. Les chats ont été anesthésiés avec une combinaison de butorphanol (0,4 mg / kg), de kétamine (7­10 mg / kg) et de médétomidine (0,03­0,05 mg / kg) appliquée par voie intramusculaire. Les chats ont été répartis au hasard pour subir une stérilisation en position de Trendelenburg (TR) (inclinaison de la tête de 70° vers le bas), en décubitus latéral (LR) ou en décubitus dorsal (DR). Les chats respiraient spontanément soit de l'air ambiant, soit de l'oxygène à raison de 2 L/minute par l'intermédiaire d'un masque facial bien ajusté. Le pouls (en battements par minute), la fréquence respiratoire (en respirations par minute) et la SpO2 (en pourcentage) ont été mesurés au départ en décubitus latéral gauche, puis en continu après avoir été placés dans la position chirurgicale attribuée. À la fin de l'opération, les chats ont été replacés en décubitus latéral gauche et tous les paramètres ont été réévalués au bout de cinq minutes. Dans l'ensemble, 33 % des chats présentaient une désaturation sévère en oxygène artériel (SpO2 < 90 %) au départ lorsqu'ils respiraient de l'air ambiant. Lorsque de l'oxygène a été ajouté pendant la procédure, la désaturation en oxygène artériel s'est résorbée chez tous les chats. À la fin de l'intervention, 29 % des chats étaient hypoxémiques lorsque l'oxygène n'était pas administré, avec un pourcentage global plus élevé de chats hypoxémiques en décubitus dorsal qu'en décubitus latéral. Tous les chats se sont bien remis de l'opération et ont été libérés dans les 24 heures suivant l'anesthésie. La désaturation en oxygène artériel est fréquente chez les chats anesthésiés par injection pour la stérilisation dans des conditions de terrain. La supplémentation en oxygène administrée via un masque étanche a résolu la désaturation en oxygène artériel dans cette population de chats sauvages, quelle que soit la position chirurgicale et la supplémentation en oxygène est donc recommandée dans tous les cas.

Metabolic syndrome and erectile dysfunction: a systematic review and meta-analysis study.

PURPOSE: The clinical significance of metabolic syndrome (MetS) versus its single components in erectile dysfunction (ED) is conflicting. Thus, the purpose is to analyze the available evidence on the relationship between MetS-along with its components-and ED. METHODS: All prospective and retrospective observational studies reporting information on ED and MetS were included. In addition, we here reanalyzed preclinical and clinical data obtained from a previously published animal model of MetS and from a consecutive series of more than 2697 men (mean age: 52.7 ± 12), respectively. RESULTS: Data derived from this meta-analysis showed that MetS was associated with an up to fourfold increased risk of ED when either unadjusted or adjusted data were considered. Meta-regression analysis, performed using unadjusted statistics, showed that the MetS-related risk of ED was closely associated with all the MetS components. These associations were confirmed when unadjusted analyses from clinical models were considered. However, fully adjusted data showed that MetS-associated ED was more often due to morbidities included (or not) in the algorithm than to the MetS diagnostic category itself. MetS is also associated with low testosterone, but its contribution to MetS-associated ED-as derived from preclinical and clinical models-although independent, is marginal. CONCLUSIONS: The results of our analysis suggest that MetS is a useless diagnostic category for studying ED. However, treating the individual MetS components is important, because they play a pivotal role in determining ED.

A data-driven model-free adaptive controller with application to wind turbines.

A data-driven controller is presented in this paper, which stems from the well known model-free adaptive control approach based on an equivalent linearized dynamical model of the plant. Inspired by the recent paper (Liu and Yang, 2019), the output tracking problem is here solved by a data-driven adaptive sliding-mode controller simultaneously ensuring prescribed performance constraints. To allow a rigorous stability analysis, the sliding variable, and the consequently derived controller, have been redesigned with respect to the inspiring paper. A proper setting of the gain of the discontinuous term is shown necessary to ensure closed loop stability. Validation of the technique has been extensively performed on the well assessed high-fidelity tool FAST (NREL) to solve the efficiency maximization problem using the proposed approach for a 5 MW wind turbine operating in the medium wind speed region.

Long-term palliation of right-sided congestive heart failure after stenting a recurrent cor triatriatum dexter in a 10½-year-old pug.

A 10½-year-old, male neutered, pug presented with increasing ascites over two months. Echocardiography revealed cor triatriatum dexter with no concurrent cardiovascular anomalies, subsequently confirmed by computed tomography angiography. Balloon dilation of the perforated intra-atrial membrane under fluoroscopic guidance resulted in the transient resolution of all clinical abnormalities, but six months later stenosis and ascites recurred. After repeated balloon dilation, a stent was placed across the membrane. The dog remains asymptomatic fourteen months after the second procedure. One noteworthy feature of this case is the onset of congestive heart failure due to a congenital defect only at more than 10 years of age.

Butorphanol induces anxiety-like -behaviour and distress in piglets.

INTRODUCTION: In a previous study that used butorphanol in pigs before castration performed under isoflurane anaesthesia, severe adverse effects were recorded. As in pigs, this has not been reported before, we aimed to investigate the effects of butorphanol in piglets. In this study ten 27 days old piglets were randomly allocated to receive either 0,2 mg/kg butorphanol (group B) or saline 0,9% (control group C) intramuscularly. Their behaviour was assessed for 60 minutes by two independent observers from videotapes. Two to 15 minutes after application, piglets in group B showed restlessness, distress and excessive vocalisation. Locomotor activity was increased, the piglets laid down considerably less frequently (p = 0,034) and for shorter time periods (p = 0,0014) during the first 40 minutes compared to group C. Group C animals slept most time of the experiment (45,1 ± 2,9 minutes in group C vs 12,7 ± 2,9 minutes in group B, p .

INTRODUCTION: Le butorphanol induit des comportements anxieux et de la détresse chez les porcelets Dans une précédente étude utilisant le butorphanol chez les porcs avant la castration réalisée sous anesthésie à l'isoflurane, des effets indésirables sévères ont été rapportés. Cela n'étant pas décrit auparavant chez les porcs, nous avons cherché à étudier les effets du butorphanol chez les porcelets. Dix porcelets âgés de 27 jours ont été répartis aléatoirement (en double aveugle) pour recevoir 0,2 mg/kg de butorphanol (groupe B) ou du sérum physiologique à 0,9% (groupe de contrôle C) par voie intramusculaire. Leur comportement a été évalué pendant 60 minutes par deux observateurs indépendants à partir d'enregistrements vidéo. Deux à 15 minutes après l'injection, les porcelets du groupe B ont présenté de l'agitation, de la détresse et des vocalisations excessives. L'activité locomotrice a augmenté : lors des 40 premières minutes, les porcelets se sont couchés significativement moins fréquemment (p = 0,034) et pour des périodes plus courtes (p = 0,0014) par rapport au groupe C. Les animaux du groupe C ont dormi la majorité du temps de l'expérience (45,1 ± 2,9 minutes dans le groupe C vs 12,7 ± 2,9 minutes dans le groupe B, p .

Gastric carcinoma and renal cell carcinoma as an atypical presentation of multiple primary malignancies: a case report and review of the literature.

BACKGROUND: Gastric carcinoma (GC) with second primary malignancy (SPM) is the most frequent combination within the multiple primary malignancies (MPM) group. The presentation of a GC associated with a synchronized SPM in the kidney is extremely rare and unusual. This study presents a rare case of synchronous tumors, describes the main associated risk factors, and emphasizes the need to rule out SPM. MAIN BODY: We present the case of a 63-year-old Hispanic woman with a history of smoking, weight loss, and gastrointestinal (GI) bleeding. GC was diagnosed by endoscopy, and during her workup for metastatic disease, a synchronous SPM was noted in the left kidney. The patient underwent resection of both tumors with a satisfactory postoperative course. A systematic review of the literature was performed using the Medline/PubMed, Science Direct, Scopus, and Google Scholar databases. A search of the literature yielded 13 relevant articles, in which the following main risk factors were reported: the treatment utilized, the grade and clinical stage, histopathological report, and in some cases survival. It is concluded that advanced age (> 60 years) and smoking are the main associated risk factors. CONCLUSION: Gastric carcinoma is the second most frequent neoplasm of the GI tract and the main neoplasm that presents a SPM. MPM screening is recommended in patients with gastric cancer. The clinical discovery of MPM of renal origin is rare and hence the importance of the current report.

Cats undergoing spay with medetomidine, ketamine and butorphanol develop arterial oxygen desaturation independent of surgical positioning and increased intraocular pressure in Trendelenburg position.

INTRODUCTION: This study observed the effects of three different surgical positions on arterial blood oxygenation measured noninvasively by pulse oximetry (SpO2) and on intraocular pressure (IOP) in anaesthetised cats undergoing spay. A total of 222 female feral cats were anaesthetised for a large-scale trap-neuter-return program with an intramuscular combination of medetomidine (0.03 - 0.05 mg/kg), ketamine (7 - 10 mg/kg) and butorphanol (0.4 mg/kg). Cats were randomly allocated to undergo spay in either Trendelenburg (70° downward head tilt), lateral or dorsal recumbency. SpO2 and pulse rate were measured at baseline, prior to surgical positioning, after one minute in surgical position and in one-minute intervals after surgical incision. Intraocular pressure was measured before positioning and at the end of surgery. At the end of surgery, all cats were placed into left lateral recumbency and all parameters were revaluated after five minutes. No significant differences between the three positions were found regarding SpO2, but an increase over time was observed. In total, 52 ± 10% (mean ± SD) of cats were hypoxaemic (SpO2 < 90%) at baseline. SpO2 improved over time, but 27 ± 3% (mean ± SD) of the cats remained hypoxaemic at the end of surgery. Trendelenburg position increased IOP during surgery (mean 31 ± 6 mmHg, individual max. 48 mmHg, versus 17 ± 4 mmHg in dorsal/lateral recumbency) but normalised after 5 mins in lateral recumbence. All cats recovered well from surgery and were released within 24 hours post-anaesthesia. Surgical position was shown to have no notable influence on SpO2 during anaesthesia in cats not receiving oxygen supplementation, whereas Trendelenburg position led to increased IOP. Oxygen supplementation is recommended with this anaesthetic protocol, as hypoxaemia is frequently observed.

INTRODUCTION: Dans cette étude, on a observé les effets de trois positions chirurgicales différentes sur l'oxygénation du sang artériel mesurée de manière non invasive par oxymétrie de pouls (SpO2) et sur la pression intraoculaire (PIO) chez des chattes anesthésiées subissant une stérilisation. Un total de 222 chattes sauvages ont été, dans le cadre d'un large programme de piégeage-castration-libération, anesthésiées avec une combinaison de médétomidine (0,03 à 0,05 mg/kg), de kétamine (7 à 10 mg/kg) et de butorphanol (0,4 mg/kg) par voie intramusculaire. Les chattes ont été réparties au hasard pour subir une stérilisation en Trendelenburg (inclinaison de la tête à 70 ° vers le bas), en décubitus latéral ou dorsal. La SpO2 et la fréquence du pouls ont été mesurées au départ, avant le positionnement chirurgical, après une minute en position chirurgicale et à des intervalles d'une minute après l'incision chirurgicale. La pression intraoculaire a été mesurée avant le positionnement et à la fin de la chirurgie. À la fin de la chirurgie, toutes les chattes ont été placées en décubitus latéral gauche et tous les paramètres ont été réévalués après cinq minutes. Aucune différence significative entre les trois positions n'a été constatée concernant la SpO2, mais une augmentation au fil du temps a été observée. Au total, 52 ± 10% (moyenne ± SD) des chattes étaient hypoxémiques (SpO2.

Assessment of subclinical atherosclerosis in hidradenitis suppurativa.

BACKGROUND: Patients with hidradenitis suppurativa (HS) have an increased prevalence of traditional cardiovascular risk factors. OBJECTIVE: Our aim was to investigate the association between subclinical atherosclerosis, detected by carotid ultrasound, and HS. METHODS: A prospective observation and analytical study assessing subclinical atherosclerosis using carotid ultrasound in patients with HS. RESULTS: A total of 62 HS patients and 62 matched controls were studied. Diabetes mellitus (22.6% vs. 6.5%, P = 0.020), hypertension (41.9% vs. 12.9%, P < 0.001) and metabolic syndrome (MetS) (38.7% vs. 8.1%, P < 0.001) were more common in HS patients. Elevated neutrophil-to-lymphocyte ratio (59.7% vs. 40.3%, P = 0.031), high-sensitivity C-reactive protein (61.1 vs. 29.0%, P < 0.001) and erythrocyte sedimentation rate (46.8% vs. 9.7%, P < 0.001) were more frequent in patients with HS. Subclinical atherosclerosis was present in 30.6% of HS patients and in 16.1% of the controls subjects (P = 0.06). After a logistic regression analysis, elevated age was associated with the presence of subclinical atherosclerosis (P < 0.001), and HS showed a tendency towards this association [adjusted OR (95% CI) 3.8 (0.9-16.0), P = 0.066]. This association was statistically significant between patients 40 years and older [OR (95% CI) 4.9 (1.8-13.1)]. CONCLUSIONS: Our clinical results indicate that patients with HS have a higher prevalence of subclinical atherosclerosis than expected when correcting for traditional risk factors. The findings support the conclusions of previous epidemiological studies.

A think tank of the Italian Society of Colorectal Surgery (SICCR) on the surgical treatment of inflammatory bowel disease using the Delphi method: ulcerative colitis.

The majority of patients suffering from ulcerative colitis (UC) are managed successfully with medical treatment, but a relevant number of them will still need surgery at some point in their life. Medical treatments and surgical techniques have changed dramatically in recent years, and available guidelines from relevant societies are rapidly evolving, providing UC experts with updated and valid practical recommendations. However, some aspects of the management of UC patients are still debated, and the application of guidelines in clinical practice may be suboptimal. The Italian Society of Colorectal Surgery (SICCR) sponsored the think tank in order to identify critical aspects of the surgical management of UC in Italy. The present paper reports the results of a think tank of Italian colorectal surgeons concerning surgery for UC and was not developed as an alternative to authoritative guidelines currently available. Members of the SICCR voted on several items proposed by the writing committee, based on evidence from the literature. The results are presented, focusing on points to be implemented. UC management relies on evaluations that need to be individualized, but points of major disagreement reported in this paper should be considered in order to develop strategies to improve the quality of the evidence and the application of guidelines in a clinical setting.

A think tank of the Italian society of colorectal surgery (SICCR) on the surgical treatment of inflammatory bowel disease using the Delphi method: Crohn's disease.

The management of Crohn's disease (CD) requires extensive expertise. Many treatment options are available, and surgery still plays a crucial role. In recent years, many medical societies have provided surgeons and gastroenterologists dealing with CD with authoritative guidelines. However, a certain degree of variation can be observed in these papers, and application of guidelines in clinical practice should be improved. The Italian society of colorectal surgery (SICCR) promoted the project reported here, which consists of a think tank of Italian colorectal surgeons to address the surgical aspects of CD management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the surgical treatment of CD. The management of CD is, by necessity, patient-tailored, and it is based on clinical data and surgeon's preference, but the committee was able to identify some points of major disagreement and suggested strategies to improve quality of available data and acceptance of guidelines.

A Study on Emotional-Affective Aspects and the Perception of General Health in Kidney Transplant Subjects.

BACKGROUND: Transplantation has profound psychological implications. Psychodiagnostic assessments with structured instruments (scales, questionnaires) may be insufficient for bringing out the deeper aspects of the personality. PATIENTS AND METHODS: Thirty kidney transplant recipients underwent the Thematic Apperception Test to detect significant variables hypothetically related to characteristics of the study sample and the SF-36 to assess quality of life. RESULTS: The variable of Thematic Apperception Test (TAT) "communication difficulties" was significantly correlated with the dimensions of the SF-36 "emotional role functioning," "social activities," and "mental health." The dimension of SF-36 "general health" did not interfere with the variable of TAT "constricted effect." CONCLUSIONS: This study is considered to be particularly useful in detecting the emergence of "removed difficulties" that transplanted subjects are not inclined to recognize. The analysis of these aspects is necessary to plan individualized psychotherapy pathways.

Role of "self-efficacy" in the process of long-term care in kidney transplant recipients.

OBJECTIVE: This study investigated the relationship between self-efficacy, quality of life, and psychic dimensions of patients with kidney transplants. Given the considerable emotional implications and the risk of psychopathology after transplantation, a protective role is assumed of the sense of self-efficacy, both from any psychopathologic disorders and from a precarious quality of life. METHODS: One hundred twenty recipients of kidney transplants from deceased donors were included in the study. The self-efficacy study was performed with the use of the General Self-Efficacy Scale. The quality of life of the subjects was studied with the use of the Short-Form Health Survey; The psychic symptoms of patients were performed using the Revised Symptom Checklist 90 (SCL-90R). RESULTS: Self-efficacy is positively correlated with both physical role limitations and mental health. With increasing self-efficacy there was a decrease of psychic symptoms as investigated with the use of the SCL-90R test. CONCLUSIONS: This study demonstrated the "protective" function of the sense of self-efficacy in the psychic sphere and its positive effect on quality of life, in the sense that an appropriate problem-solving strategy helps the transplant patient to maintain good mental and physical health.

The concept of self and emotional involvement in living kidney donation: a psychometric investigation.

OBJECTIVE: The aim of our study was to analyze, from a psychological point of view, living kidney donor personality, examining a sample of 18 living kidney donors. PATIENTS AND METHODS: The personality study was performed using The Millon Clinical Multiaxial Inventory-III in 18 potential kidney donors, 6 of whom were genetically and 12 emotionally related individuals. RESULTS: Our study showed the presence of narcissistic, histrionic, and obsessive-compulsive personality traits in living kidney donors. CONCLUSIONS: It is necessary to explore the development of motivation for living donation in order to achieve and maintain a harmonious relationship with the recipient while respecting their individuality.

The study of personality in renal transplant patients: possible predictor of an adequate social adaptation?

BACKGROUND: This study explored the personality characteristic traits within a sample of renal transplant patients, seeking to obtain predictive index for likely clinical impacts. PATIENTS AND METHODS: The personality study was performed using the Structured Clinical Interview Axis II Personality Disorders for Diagnostic and Statistical Manual of Mental Disorders fourth edition, text revision in 60 recipients of kidney transplantations from deceased donors. RESULTS: The personality trait that prevailed in the female gender was borderline, while in the male gender it appeared to be predominantly obsessive-compulsive personality trait. CONCLUSIONS: The personality study proved to be a good index to predict effects on the level of social adjustment. In this way, patients who have shown pathologic personality traits can be identified early to provide adequate psychologic-psychiatric support and follow-up.

Predictive value of the Charlson comorbidity index in kidney transplantation.

BACKGROUND: Nonimmunologic factors have been recently implicated in worse outcomes after kidney transplantation, producing a need to predict the operative risk among kidney recipients. We assessed the predictive value of the Charlson comorbidity index (CCI) among kidney transplant recipients. METHODS: A retrospective study of 223 first deceased-donor kidney transplantations performed from 2000 to 2007 evaluated the role of comorbidities. RESULTS: About 50% of recipients displayed >1 comorbid condition before transplantation; the most frequently reported was diabetes mellitus. Increasing CCI scores significantly affected graft and patient survivals. Crude analysis showed a significant association between CCI >1 and risk of death (hazard ratio [HR], 3.87; 95% confidence interval [CI], 1.06-14.06; P = .04). After adjustment for several covariates, high CCI values remained significantly predictive of posttransplantation outcomes with a HR for death of (12.53; 95% CI, 1.9-82.68; P = .009). CONCLUSIONS: Our predictive model showed a strong association of CCI and patient survival even after adjustment for several clinical covariates. CCI may be used to evaluate patients referred for kidney transplantation who display a significant burden of comorbid conditions that increase the risk of premature death or graft loss.

The role of obesity in kidney transplantation outcome.

BACKGROUND: The number of obese kidney transplant candidates has been growing. However, there are conflicting results regarding to the effect of obesity on kidney transplantation outcome. The aim of this study was to investigate the association between the body mass index (BMI) and graft survival by using continuous versus categoric BMI values as an independent risk factor in renal transplantation. METHODS: We retrospectively reviewed 376 kidney transplant recipients to evaluate graft and patient survivals between normal-weight, overweight, and obese patients at the time of transplantation, considering BMI as a categoric variable. RESULTS: Obese patients were more likely to be male and older than normal-weight recipients (P = .021; P = .002; respectively). Graft loss was significantly higher among obese compared with nonobese recipients. Obese patients displayed significantly lower survival compared with nonobese subjects at 1 year (76.9% vs 35.3%; P = .024) and 3 years (46.2% vs 11.8%; P = .035). CONCLUSIONS: Obesity may represent an independent risk factor for graft loss and patient death. Careful patient selection with pretransplantation weight reduction is mandatory to reduce the rate of early posttransplantation complications and to improve long-term outcomes.

Correlational study between psychic symptoms and quality of life among hemodialysis patients older than 55 years of age.

BACKGROUND: The loss of renal function and urination with dialysis can produce a strong emotional crisis in a patient. This study explored the correlation between psychic symptoms and quality of life among hemodialysis patients who were older than 55 years of age in relation to demographic characteristics of age, time on dialysis, and education. PATIENTS AND METHODS: Twenty patients undergoing hemodialysis were included in the study. The psychic symptoms were studied using the Symptom Checklist-90. Revised (SCL-90 R) and the quality of life was studied using the Complete Form Health Survey (SF 36). RESULTS: The high correlation between psychological sizes investigated through the SCL-90 R test and those for the SF-36 test confirmed the close relationship between physical disorders and mental suffering, and reduced vitality, and lack of socialization. CONCLUSION: The psychiatrist and psychologist may help hemodialysis patients to improve their quality of life by providing new coping strategies for each of the family, occupational, and social network.

Delayed graft function and long-term outcome in kidney transplantation.

BACKGROUND: There are still many controversies about the impact of delayed graft function (DGF) on kidney transplantation outcome. The aims of this study were to define factors associated with DGF and to ascertain the relative impact of DGF on kidney transplantation outcome, both in the early postoperative period and in long-term follow-up. PATIENTS AND METHODS: Four hundred kidney transplant recipients were reviewed to assess the clinical impact of DGF on long-term outcome. RESULTS: The overall prevalence of DGF was 24.3%. DGF was significantly associated with increasing recipient and donor age, duration of dialysis, and cold ischemia time. Patients with DGF displayed a significantly worse graft (P = .005) and patient (P < .001) survival compared with recipients with immediate function. CONCLUSION: DGF is a frequent complication of renal transplantation and may be associated with a reduced graft and even patient survival. Strategies to prevent graft injury and, more specifically, DGF may be an important clue to provide a better long-term outcome in kidney transplantation.