Delayed graft function: immediate and late impact.

Delayed graft function remains a frequent problem after renal transplantation, which is often associated with subsequent graft failure. The major risks for delayed graft function are incurred during organ procurement, preservation, and transplantation, and are predominated by ischemic injury. The cofactors associated with delayed graft function that lead to subsequent poor outcome include early acute rejection as well as immunologic risk factors for rejection, such as presensitization, human leukocyte antigen mismatch, and previous loss of graft. Numerous diagnostic and therapeutic approaches have been assessed in recent years, but predicting or modifying adverse outcomes associated with delayed graft function in a given patient remains unreliable.