Purpose of ReviewThe number of people with end-stage kidney disease requiring renal replacement therapy is growing at a faster rate than the number of kidneys available for transplant. Additional options for deceased donor kidney transplant will increase risk for delayed graft function, which has expansive clinical, performance, and financial implications. The purpose of this paper is to discuss how delayed graft function impacts different domains.Recent FindingsGiven that most kidney transplants in the USA are performed with deceased donors, expanding the deceased donor pool is likely to be of the highest impact. The potential additional sources of deceased donors include increasing organ donation in general and willingness to change perspectives about acceptable kidneys for transplant. An important implication of expanding criteria for acceptable kidneys for transplant is the risk for delayed graft function, what is expected, and how do we manage a potential increase burden for patients, transplant centers, and organ procurement organizations. Given the directives of Advancing American Kidney Health policies, it is important that we are thorough and thoughtful about navigating the post-transplant experience for patients and providers. The breadth of impact ranges from exploring the additional resources patients require to manage the social and financial complications associated with delayed graft function to balancing transplant centers’ challenge to provide excellent clinical care in a standard fashion against desire to transplant all eligible candidates.SummaryThis paper summarizes the historical approach to delayed graft function and proposes a dynamic framework for an improved system to review impact to the multiple stakeholders.

Abstract We study the incidence of delayed graft function (DGF) in a group of 3365 renal transplant recipient patients from various Spanish centres, its clinical consequences, and the evolution in time (transplants performed in 1990, 1994 and 1998) of the factors that determine its presence. The incidence of DGF remained constant in the 3 years studied (30.4, 30.8 and 29.2%, respectively) when contrasting the following factors involved in the establishment of DGF were studied: body mass of recipient, donor age, non-heart beating donation, type of replacement treatment in the pre-transplant period, time of vascular anastomosis and time of cold ischaemia. DGF was not associated with graft or patient survival. In the transplants performed with elderly donors, the cold ischaemia time was associated with greater incidence of DGF, and the latter with less survival of the graft when censored for death. The presence of DGF was significantly associated with acute rejection, cytomegalovirus infection, worse renal function and arterial hypertension at 3 months post-transplantation. In conclusion, the incidence of DGF remained stable in our patients over the years studied and, although not directly, it can affect graft survival as it is associated with acute rejection, arterial hypertension and worse renal graft function. A shortening of ischaemia times may reduce the incidence of DGF and improve transplant results. chronic allograft nephropathy, delayed graft function, kidney transplantation Author notes 1Nephrology Department, Fundació Puigvert, Barcelona, Spain, 2Nephrology Department, Hospital Sondureta, Palma de Mallorca, Spain, 3Nephrology Department, Hospital La Paz, Madrid, Spain and 4Nephrology Service, Hospital Univ. Virgen de las Nieves, Granada, Spain Nephrol Dial Transplant Vol. 19 Suppl 3 © ERA–EDTA 2004; all rights reserved