The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review

Am J Transplant. 2015 Jul;15(7):1903-14. doi: 10.1111/ajt.13213. Epub 2015 Mar 13.


Despite a growing organ shortage in the United States, many deceased donor kidneys removed for transplantation are discarded. Kidney biopsy findings often play a role in these discards, although it is not clear whether biopsies reliably inform acceptance decisions. Therefore, we carried out a systematic review of the medical literature on the utility of both procurement and implantation biopsies for predicting posttransplant outcomes. Between January 1, 1994 and July 1, 2014, 47 studies were published in the English language literature that examined the association between pretransplant donor biopsy findings from 50 or more donors (with more than half being from deceased donors) and either posttransplant graft failure, delayed graft function, or graft function. In general, study quality was poor. All were retrospective or did not indicate if they were prospective. Results were heterogeneous, with authors as often as not concluding that biopsy results did not predict posttransplant outcomes. The percent glomerular sclerosis was most often examined, and failed to predict graft failure in 7 of 14 studies. Of 15 semiquantitative scoring systems proposed, none consistently predicted posttransplant outcomes across studies. Routine use of biopsies to help determine whether or not to transplant a kidney should be reexamined.

Keywords: biopsy; clinical research/practice; delayed graft function (DGF); editorial/personal viewpoint; function/dysfunction; graft survival; kidney (allograft); kidney transplantation/nephrology.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Biopsy
  • Graft Rejection / physiopathology
  • Graft Survival / physiology
  • Humans
  • Kidney / pathology*
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation*
  • Meta-Analysis as Topic
  • Nephrosclerosis / diagnosis*
  • Tissue Donors*
  • Tissue and Organ Procurement
  • Transplant Recipients