The postoperative management of a kidney transplant recipient requires meticulous monitoring of urine output and electrolyte levels. Renal allografts will not necessarily make urine as soon as they are reperfused. Depending on the particular center, the incidence of delayed graft function ranges from 5% to 15% in cadaveric and from 0% to 5% in live donor kidney transplantation. The astute clinician will query the patient as to how much urine was produced pretrans-plant so as not to be lulled into a false assurance that the graft is functioning because “there is urine.”

Although no physician can predict the postoperative urine output of a kidney recipient with 100% certainty, there are several factors that consistently contribute to delayed graft function. Cadaveric donors, increased age of donors, ethnicity of donors, diabetic donors, prolonged warm and cold ischemia, and ischemia/reperfusion injury are all risk factors for delayed graft failure resulting from acute tubular necrosis. It must be remembered that delayed graft function begins at the time of organ reperfusion and the urine output begins and remains low and does not change abruptly.