Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Aug 26, 2019; 9(4): 58-61
Published online Aug 26, 2019. doi: 10.5500/wjt.v9.i4.58
Blessing and a curse of outpatient management of delayed graft function
Justin W Blazel, Jennifer A Turk, Brenda L Muth, Sandesh Parajuli
Justin W Blazel, Jennifer A Turk, Brenda L Muth, Sandesh Parajuli, Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, United States
Author contributions: Blazel JB designed and prepared the manuscript; Turk JA edited the manuscript; Muth BL designed and edited the manuscript; Parajuli S concept, designed and edited manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sandesh Parajuli, MBBS, MD, Assistant Professor, Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, UW Medical Foundation Centennial Building 4175, 1685 Highland Avenue, Madison, WI 53705, United States. sparajuli@medicine.wisc.edu
Telephone: +1-608-2650152
Received: March 21, 2019
Peer-review started: March 24, 2019
First decision: June 7, 2019
Revised: July 13, 2019
Accepted: August 6, 2019
Article in press: August 7, 2019
Published online: August 26, 2019

Delayed graft function (DGF) is a common complication occurring most often after deceased donor kidney transplant with several donor characteristics as well as immunologic factors that lead to its development post-transplant. These patients require dialysis and close kidney function monitoring until sufficient allograft function is achieved. This has resulted in limited options for DGF management, either prolonged hospitalization until graft function improves to the point where dialysis is no longer needed or discharge back to their home dialysis unit with periodic follow up in the transplant clinic. DGF is associated with a higher risk for acute rejection, premature graft failure, and 30-d readmission; therefore, these patients need close monitoring, immunosuppression management, and prompt allograft biopsy if prolonged DGF is observed. This may not occur if these patients are discharged back to their home dialysis unit. To address this issue, the University of Wisconsin-Madison created a clinic in 2011 specialized in outpatient DGF management. This clinic was able to successfully reduce hospital length of stay without an increase in 30-d readmission, graft loss, and patient death.

Keywords: Delayed graft function, Kidney transplantation, Immunosuppression, Acute rejection, Kidney donor profile index, Kidney donor risk index, Dialysis

Core tip: Delayed graft function (DGF), traditionally defined as needing dialysis within seven days following kidney transplant, occurs most often after deceased donor kidney transplantation. Both donor characteristics, as well as immunologic factors, influence the development of DGF. Historically, outpatient management has been difficult, often leading to increased length of stay (LOS), however, the DGF clinic at University of Wisconsin - Madison which was established in 2011 has shown that it is possible to provide high-quality outpatient DGF management without increasing LOS, 30-d readmission, or acute rejection rates.