Delayed graft function in kidney transplantation: a review of contemporary challenges and updates

Delayed graft function (DGF) is commonly defined as dialysis needed within one week post-transplant. DGF is a common early post-transplant complication associated with detrimental outcomes. To overcome the shortage of donors, the criteria for selecting deceased donors have been liberalized. Increased associated risks with DGF-associated transplants, including donors with acute kidney injury, older age donors, prolonged cold ischemia time, and out-of-sequence kidneys, have become increasingly prevalent. There is currently no Food and Drug Administration (FDA)-approved DGF-related therapy. Previous strategies implemented to prevent adverse outcomes related to DGF include donor-recipient matching, kidney offers for preemptive transplant with a high risk for DGF, machine perfusion, and more. In this manuscript, we discuss pertinent updates regarding DGF in policy, epidemiology, diagnostics, and therapeutics to supplement the literature and to foster ongoing research.