- Use only for a deceased-donor kidney transplant (DGF is defined as the need for dialysis within the first 7 days post-transplant). Living-donor grafts rarely develop DGF and are out of scope.
- Answer the recognized donor and recipient risk factors below. The qualitative low / moderate / high risk impression updates automatically as you change any answer.
- This is a weighted-factor impression, not a validated probability. For a precise numeric DGF probability, open the authoritative Irish 2010 web calculator linked in the result.
- Interpret alongside the donor KDPI/KDRI, the planned induction and CNI strategy, and the full clinical picture.
All computation runs in your browser; no values are stored or transmitted.
When to Use
Use this tool at the time of a deceased-donor kidney transplant offer or before the operation to gauge the likelihood of delayed graft function — the need for dialysis in the first post-transplant week. Pre-transplant DGF risk informs the consent conversation, the choice of induction immunosuppression (e.g., depleting vs. non-depleting agents), the calcineurin-inhibitor strategy and timing, surgical logistics aimed at shortening cold ischemia time, and planning for likely post-operative dialysis and biopsy surveillance.
Appropriate population
Adult recipients of a deceased-donor kidney (donation after brain death or after circulatory death/DCD). Most useful when the key donor data — age, terminal creatinine, cause of death, DCD status, KDPI/KDRI — and the recipient data — BMI, diabetes, sensitization (PRA), prior transplant, dialysis vintage — are known, alongside the anticipated cold ischemia time.
When NOT to rely on it
This is a qualitative impression, not the validated Irish probability — do not quote its tier as a percentage. It does not apply to living-donor transplants (DGF is uncommon) and does not predict primary non-function, rejection, or long-term graft survival on its own. For a calibrated numeric DGF probability, use the authoritative Irish 2010 web calculator; always integrate any estimate with donor KDPI/KDRI and the full clinical context.
Pearls & Pitfalls
Cold ischemia time is the most modifiable driver
Across studies the observed DGF rate climbs steadily with cold ischemia time, and CIT is the factor the transplant team can most directly influence on the day. Among the recognized predictors, the strongest signals in the Irish dataset were prolonged cold ischemia time, higher donor terminal creatinine, recipient BMI, and DCD donation. Aggressively minimizing CIT is the single most actionable lever.
Donor quality now dominates immunology
In the current era the weight of immunologic factors (HLA mismatch, PRA) has attenuated, while the contribution of donor renal function has roughly doubled. KDPI/KDRI summarize donor quality and track closely with DGF — pair this impression with the donor's KDPI when one is available.
Pitfalls
(1) A tier of "low" does not mean DGF will not occur — even ideal grafts develop DGF some of the time. (2) Do not present this qualitative tier as a percentage; only the validated Irish calculator yields a calibrated probability. (3) DGF is dialysis-dependent by definition; "slow graft function" (rising urine output, falling creatinine, no dialysis) is a distinct, milder phenotype not captured here. (4) The tool does not account for technical/surgical complications, recurrent disease, or hyperacute/accelerated rejection.
Why Use It
Delayed graft function is not a benign hiccup: it prolongs hospitalization, complicates immunosuppression dosing and biopsy interpretation, increases the risk of acute rejection, and is associated with worse long-term graft survival. Knowing the DGF risk before the transplant lets the team set expectations with the recipient, choose induction and calcineurin-inhibitor strategy deliberately, and organize logistics to shorten cold ischemia time. A structured review of the recognized donor and recipient drivers — rather than an unaided gestalt — makes the risk discussion reproducible and points to the levers that can actually be modified. For a precise, calibrated probability, this tool defers to the validated Irish 2010 web calculator.
Delayed Graft Function (DGF) Risk — Qualitative Tier
Answer the recognized donor and recipient drivers below for a deceased-donor kidney transplant. The tool returns a qualitative low / moderate / high DGF-risk impression weighted by the strength of each factor. This is not a validated probability — for a calibrated DGF percentage, open the authoritative Irish 2010 web calculator from the result.
For a precise probability, use the authoritative calculator
The published Irish 2010 DGF nomogram (the model behind transplantcalculator.com/DGF) returns a calibrated DGF probability from the full donor/recipient dataset. The exact regression coefficients are not reproduced here — this page gives a qualitative impression only. Open the Irish DGF calculator →
⚕ Qualitative weighted-factor impression based on the recognized DGF drivers reported by Irish WD, et al. (Am J Transplant. 2010;10[10]:2279–2286) and related literature. It is not the validated Irish probability and must not be quoted as a percentage. For a calibrated DGF probability use the Irish 2010 web calculator (transplantcalculator.com/DGF). For licensed clinicians; not a substitute for individualized assessment.
Next Steps
Use the risk tier to plan mitigation, immunosuppression, and post-operative monitoring.
- Minimize cold ischemia time — the most modifiable driver. Streamline logistics, reduce avoidable delays, and consider machine (hypothermic/normothermic) perfusion where available, which can lower DGF for higher-risk grafts.
- Choose induction deliberately — depleting induction (e.g., antithymocyte globulin) is often favored for higher-risk pairings; weigh against infection risk and local protocol.
- Plan the CNI strategy — consider reduced-dose or delayed calcineurin-inhibitor introduction in high-risk grafts to limit added nephrotoxic insult while the graft recovers.
- Prepare for post-operative dialysis and surveillance — anticipate early dialysis access/need, and have a low threshold for allograft biopsy to distinguish ongoing acute tubular injury from rejection during DGF.
- For a calibrated probability, run the Irish 2010 web calculator, and review donor quality with KDPI & KDRI; track recovery with the allograft eGFR trend.
Evidence & References
What this tool does
The definitive model is the Irish 2010 multivariable logistic regression nomogram, derived from 24,337 deceased-donor recipients (2003–2006) and implemented as the web calculator at transplantcalculator.com/DGF (model discrimination, AUC ≈ 0.70). Its predicted probability follows the standard logistic form: P(DGF) = 1 / (1 + e−(β₀ + Σβx)). The published model's individual coefficients are not reproduced here; to avoid presenting unverified numbers, this page instead gives a qualitative tier from the recognized drivers and defers to the official calculator for a calibrated probability.
Recognized DGF drivers (Irish 2010 and related literature)
| Factor | Direction of effect |
|---|---|
| Cold ischemia time | ↑ DGF with longer CIT — strongest modifiable driver |
| Donor type (DCD) | DCD ↑ DGF substantially vs. DBD |
| Donor terminal creatinine | Higher ↑ DGF — donor-function weight ~doubled in current era |
| Donor age / KDPI–KDRI | Older / marginal donor ↑ DGF |
| Donor cause of death (CVA) | Cerebrovascular death modestly ↑ DGF |
| Recipient BMI | Higher BMI ↑ DGF |
| Recipient diabetes | ↑ DGF |
| Sensitization (PRA) / HLA mismatch | ↑ DGF (immunologic weight attenuated over time) |
| Prior transplant; dialysis vintage | Re-transplant and longer vintage ↑ DGF |
Why DGF matters
DGF (dialysis within the first post-transplant week) increases the risk of acute rejection, prolongs hospitalization, complicates immunosuppression and biopsy interpretation, and is associated with worse long-term graft survival. Mitigation centers on minimizing cold ischemia time, induction choice, and calcineurin-inhibitor strategy.
References
- Irish WD, Ilsley JN, Schnitzler MA, Feng S, Brennan DC. A risk prediction model for delayed graft function in the current era of deceased donor renal transplantation. Am J Transplant. 2010;10(10):2279–2286. doi:10.1111/j.1600-6143.2010.03179.x. (Model hosted at transplantcalculator.com.)
- Mannon RB. Delayed graft function: the AKI of kidney transplantation. Nephron. 2018;140(2):94–98. doi:10.1159/000491558.
- Siedlecki A, Irish W, Brennan DC. Delayed graft function in the kidney transplant. Am J Transplant. 2011;11(11):2279–2296. doi:10.1111/j.1600-6143.2011.03754.x.
