Delayed graft function after kidney transplantation: the clinical perspective.

Delayed graft function continues to pose a significant challenge to clinicians in the context of kidney transplantation. With the present disparity between supply and demand for organs, transplantation is proceeding with more marginal kidneys and therefore the problem of delayed graft function is likely to increase in the future. Although our understanding of the mechanism and risk factors for delayed graft function has improved, translation of this understanding into targeted clinical therapy to attenuate or manage established delayed graft function has been elusive. Based on current trends, the use of kidneys from expanded criteria or cardiac death donors will continue to expand, which will increase the prevalence of delayed graft function in the immediate postoperative setting. The aim of this article is to discuss and critique the available clinical evidence for targeted intervention in the prevention and management of delayed graft function and review emerging and experimental therapies.