Time-Zero Kidney Biopsy and Deceased-Donor Transplant Outcomes: A Systematic Review and Meta-Analysis of Prognostic Value, Prediction, and Clinical Utility
In brief
Time-zero biopsies linked glomerulosclerosis to doubled graft failure, with very uncertain evidence
In a review of 203 reports, glomerulosclerosis was associated with about twice the hazard of graft failure, while vascular injury was linked to higher rates of graft failure and delayed function. But all pooled evidence was judged very low certainty, and whether biopsy adds useful prediction beyond clinical factors remains unknown, so findings should not decide kidney acceptance or discard alone.
- Journal
- Medical sciences (Basel, Switzerland) (Q1)
- Published
- 12 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Livier Sainz-Bravo, Benjamín Gómez-Navarro, Diana Laura Figueroa-Gamiño, Jenniffer Topacio Tapia-Báez, José David González-Barajas, Manuel Luis Prieto-Magallanes, et al.
- PMID
- 42783439
- DOI
- 10.3390/medsci14050566
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (paper of the day, 26 September 2026): Time‑zero kidney biopsy prognostic meta‑analysis, transplant pathology
Abstract
Background/Objectives: Time-zero biopsy informs deceased-donor kidney implantation or discard, but its prognostic value is contested. We systematically reviewed pre-reperfusion morphological biopsy evidence in adult deceased-donor kidney transplantation, keeping four questions separate: prognostic association, incremental prediction, clinical utility and measurement reproducibility. Methods: We searched PubMed/MEDLINE, Embase, Scopus, Web of Science, CENTRAL and three trial registries through 25 July 2026 without date or language restriction. One estimate per non-overlapping cohort was selected under a prespecified hierarchy; random-effects models used restricted maximum likelihood with Hartung-Knapp inference; GRADE assessed certainty. Results: Of 45,676 records, 25,746 were screened; 203 eligible reports (159 study investigations and 154 cohort families) and 22 contextual reports were included. Vascular injury was associated with delayed graft function (odds ratio: 1.85, 95% CI 1.11-3.06), glomerulosclerosis with graft failure (hazard ratio: 2.03, 1.22-3.39) and vascular injury with graft failure (hazard ratio: 1.48, 1.07-2.04); glomerulosclerosis with delayed graft function was inconclusive (odds ratio: 1.13, 0.59-2.17). All 12 pooled bodies were of very low certainty. Conclusions: Current evidence does not support time-zero histology as a stand-alone rule for accepting or discarding a deceased-donor kidney. Whether standardized histology adds predictive information beyond established clinical variables remains open and should be addressed in linked registry analyses before biopsy findings guide management.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.