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 at least 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. Supportive care, such as dialysis or diuretics (water pills) may be needed after your transplant. Your doctor may biopsy the kidney to check for rejection. You will have to follow salt, 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 functions normally like any other transplanted kidney.
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. In other cases, it may 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 volume status.
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. You should continue to take your phosphate binder medicine. When you are at home or in the hotel you must check your weight and blood pressure every 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.
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The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 11/22/2011
Copyright © 11/22/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7103
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