Acute Tubular Necrosis
In most cases, the transplanted kidney begins to make urine right away. Sometimes though, the kidney may have delayed function after surgery. This problem is called delayed graft function or acute tubular necrosis (ATN). Delayed graft function can occur as a result of factors related to the donor such as low blood pressure during CPR.  Delayed graft function may also happen if the kidney has been stored for many hours after removal from the donor.  It may also happen if the transplant recipient has unexpected bleeding during surgery or during a biopsy.

In some cases, your doctor can predict that delayed graft function will occur but other times it may happen unexpectedly.

There is no specific treatment for this problem.  You will just need to patiently wait for your kidney to start working.  Dialysis may be required for a few weeks or as long as three months.
Delayed graft function or ATN is suspected when the creatinine does not fall quickly after transplant.  In mild cases, the creatinine may come down only very slightly each day.  If the creatinine remains high, there is no way to tell for sure whether rejection is also happening.  In these cases, a biopsy is usually done so that your doctors can treat any rejection quickly.

Primary Non-Function
Primary non-function is when the transplanted kidney never starts working.  This is rare, however, it can happen.  It is a very discouraging event for the patient, as well as the transplant team.  Dialysis is usually required in the first 48 hours after surgery and will continue to be required on a regular basis.  Patients with primary non-function have a renal biopsy that reveals irreversible damage. In most cases the transplanted kidney needs to be removed.  Primary non-function does not prevent you from having another transplant, and the Transplant Center can request reinstatement of your original wait time allowing re-transplant to happen sooner.

Infection is a constant risk to transplant recipients.  The immunosuppressive medications that you take to prevent rejection cause you to be at increased risk for infections. You will take antibiotics to prevent infection for the first 3-6 months after your transplant.

As a dialysis patient you were trained to avoid extra fluid.  When you have a functioning kidney, restricting fluid can lead to dehydration.  During summer months it is especially important to drink plenty of fluids because the water loss from heat/perspiration can cause dehydration and your creatinine to rise.

Urine Leak
The ureter is a tube that drains urine from your transplanted kidney to the bladder.  An incision is made in the bladder so the ureter can be stitched to the bladder.  If the bladder becomes too full before the incision in the bladder has healed, then the ureter can pull away from the bladder and urine can leak out. If a urine leak occurs, the urine draining from your catheter will stop.  Usually this occurs abruptly.  As the urine drains into the area around the kidney, you may develop pain.  The only treatment for this problem is an operation to reconnect the ureter.

One of the reasons that you will have a catheter is to keep the bladder from becoming too full.  Once your catheter is removed, it is important for you to go to the bathroom frequently during the first few days to prevent the bladder from becoming very full.  Most patients will feel the urge to go to the bathroom frequently.  This is because the bladder shrinks over time when your kidneys do not make urine.  When the transplanted kidney produces large amounts of urine, you may feel like going to the bathroom often.