Delayed Graft Function (DGF)
What is delayed graft function (DGF)?
Your transplanted kidney is called a graft. Delayed graft function (DGF) occurs right after
surgery. It means your new kidney is not working as it should and you still need dialysis. You
may hear your transplant team say that the kidney is “sleepy”. This means you have delayed
graft function. It takes some time for the kidney to heal from the transplant surgery. Some
people may require dialysis for a time after their transplant. Up to 30% of deceased-donor
kidneys and 5% of living-related donor kidneys may have some degree of DGF.
How do I know I have DGF?
With DGF, your new kidney may make little or no urine. Kidney lab values (BUN and
creatinine) remain high in your blood tests. After transplant, it is common for kidneys to have
some DGF before they start to work. During this time, if you were on dialysis before the
transplant, you will continue to need dialysis usually 3 times a week. If you were not on dialysis,
your old kidneys will still make urine. The transplanted kidney will not be able to clear the
wastes from your blood. You may have to be placed on dialysis for a short time to clear the
wastes from the blood until the new kidney starts to work properly.
How is DGF treated?
The function of your new kidney is checked by lab work. Your urine output is also checked.
You may need supportive care, such as dialysis or diuretics (water pills) and close monitoring of
your kidney function. Your doctor may biopsy the kidney to check for rejection. You will have
to follow salt, potassium, phosphorous, and water restrictions similar to the plan you were
following before the transplant. The transplant team will decide when this diet plan is no longer
needed. Your blood pressure, anti-rejection, and other medicines will be adjusted as needed.
Also, changes in your diet, fluid intake, and diuretics may be needed.
Will my kidney recover from DGF?
Yes. The vast majority of transplanted kidneys with DGF recover. At UWHC, 95% of kidney
transplants are working one year after transplant. Only 1 to 2% of all kidney transplants fail to
work. After the kidney starts working, it will function like any other transplanted kidneys.
How long will DGF last?
There is no exact time line for how long DGF will last. It will vary from patient to patient.
Sometimes DGF starts getting better within a few days, but can take a number of weeks.
What is the Delayed Graft Function (DGF) Clinic?
The DGF clinic is set up so that so we can follow you closely. You do not have to stay in the
hospital until your DGF improves. If you live close to UWHC (less than 50 miles) you can be
discharged from the hospital and go home. If you live far away from UWHC (greater than 50
miles) you will likely stay in a hotel close to the hospital. You may need to return to the clinic as
often as every day or every other day. We need to closely follow your kidney function and fluid
In order to be discharged you must
Be able to walk and move as well as you did before surgery.
Be able to eat a regular diet without having nausea or vomiting.
Have stable vital signs.
Have no other acute medical issues.
Have a support person staying with you (either at home or in the hotel).
Have transportation to and from the clinic for your visits.
What will happen after I am discharged?
When you are discharged from the hospital you will receive instructions from your nurse. You
will have to limit your fluid intake just like when you were on dialysis before your transplant.
You should also limit salt, phosphorous and potassium in your diet. This is called a renal diet.
When you are at home or in the hotel you must check your weight daily and blood pressure twice
each day. You will be given a urine collection device. You will measure how much urine you
are making each day. It is important to record how much urine you are making. Bring the
record with you to each clinic visit. This is an important sign of your transplanted kidney
starting to work.
If you are being discharged with a new dialysis line, your nurse will tell you how to take care of
that line. Most often, it will be cared for by nurses in the Transplant Clinic.
Delayed Graft Function Clinic
You will return to UW three times a week for labs, dialysis and clinic appointments with
transplant nephrology. Sometimes you may have to return for an extra visit. You will have labs
drawn here in the lab before your clinic visit. After your clinic visit, it will be decided if you
need dialysis on that day. If you need dialysis, this can be done in our dialysis unit at the
hospital. We will also decide if your anti-rejection, blood pressure, and anemia medicines need
to be adjusted. You will also have a clinic visit with your transplant surgeon about 2 weeks after
discharge. When you no longer need dialysis, you will be discharged from the delayed graft
function clinic. You will return to the UW transplant clinic for routine follow-up visits.
If you are having any problems, call your transplant coordinator. The transplant coordinator may
ask you to go to the hospital emergency department for evaluation. For urgent issues on
weekends/evenings/holidays call 608-263-6400. Ask for the Transplant Coordinator on call.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©1/2016. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7103.
Total Urine Output
Date Total Urine Output