Delayed graft function (DGF), most commonly defined as the need for dialysis in the first 7 days post-transplant, continues to be a common problem in the modern era of kidney transplantation. Multiple complex biochemical and structural changes occur at the cellular level as a result of ischemia and reperfusion injury of the allograft, which predispose recipients to DGF. Several transplant, donor, and recipient factors have been found to be associated with an increased risk of DGF. This chapter will provide an overview of these risk factors as well as a practical approach to the clinical evaluation of DGF. A number of preventive and therapeutic interventions such as the use of certain preservation solutions, pulsatile machine perfusion, vasodilatory drugs, and immunosuppressive agents have been extensively studied with variable results. These interventions, as well as the quality of the evidence supporting their use, will also be reviewed. Finally, this chapter will highlight the short- and long-term consequences of DGF, with a particular emphasis on the association between DGF, graft survival, and death with graft function.