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Volume 14
Issue 5
10.3390/medsci14050566
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Systematic Review

Time-Zero Kidney Biopsy and Deceased-Donor Transplant Outcomes: A Systematic Review and Meta-Analysis of Prognostic Value, Prediction, and Clinical Utility

by
Livier Sainz-Bravo
1,
Benjamín Gómez-Navarro
2,3,
Diana Laura Figueroa-Gamiño
4,
Jenniffer Topacio Tapia-Báez
5,
José David González-Barajas
1,6,
Manuel Luis Prieto-Magallanes
1,7,
José Ángel Solís-Rojas
8,
Edgar Bautista-Reyes
9,
Juan Alberto Gómez-Fregoso
6,10,
Judith Carolina De Arcos-Jiménez
1,7,
Ramón Medina-González
7,10,
Violeta Aidee Camarena-Arteaga
1,
Manuel Arizaga-Napoles
10 and
Jaime Briseno-Ramirez
1,7,*
1
Hospital Civil de Oriente, Tonalá 45425, Mexico
2
Consejo Estatal de Trasplantes de Jalisco (CETRAJAL), Guadalajara 45177, Mexico
3
Centro Médico Puerta de Hierro Norte, Zapopan 45116, Mexico
4
Hospital Juárez de México, Mexico City 07760, Mexico
5
Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico
6
Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
7
Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco 45641, Mexico
8
Hospital Regional de Alta Especialidad del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Acapulco 39850, Mexico
9
Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City 03229, Mexico
10
Antiguo Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara 44280, Mexico
*
Author to whom correspondence should be addressed.
Med. Sci. 2026, 14(5), 566; https://doi.org/10.3390/medsci14050566 (registering DOI)
Submission received: 13 August 2026 / Revised: 7 September 2026 / Accepted: 10 September 2026 / Published: 12 September 2026
(This article belongs to the Section Nephrology and Urology)
Review Reports Versions Notes

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.
Keywords: kidney transplantation; deceased donor; procurement biopsy; delayed graft function; prognosis; decision utility; meta-analysis kidney transplantation; deceased donor; procurement biopsy; delayed graft function; prognosis; decision utility; meta-analysis

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MDPI and ACS Style

Sainz-Bravo, L.; Gómez-Navarro, B.; Figueroa-Gamiño, D.L.; Tapia-Báez, J.T.; González-Barajas, J.D.; Prieto-Magallanes, M.L.; Solís-Rojas, J.Á.; Bautista-Reyes, E.; Gómez-Fregoso, J.A.; Arcos-Jiménez, J.C.D.; et al. Time-Zero Kidney Biopsy and Deceased-Donor Transplant Outcomes: A Systematic Review and Meta-Analysis of Prognostic Value, Prediction, and Clinical Utility. Med. Sci. 2026, 14, 566. https://doi.org/10.3390/medsci14050566

AMA Style

Sainz-Bravo L, Gómez-Navarro B, Figueroa-Gamiño DL, Tapia-Báez JT, González-Barajas JD, Prieto-Magallanes ML, Solís-Rojas JÁ, Bautista-Reyes E, Gómez-Fregoso JA, Arcos-Jiménez JCD, et al. Time-Zero Kidney Biopsy and Deceased-Donor Transplant Outcomes: A Systematic Review and Meta-Analysis of Prognostic Value, Prediction, and Clinical Utility. Medical Sciences. 2026; 14(5):566. https://doi.org/10.3390/medsci14050566

Chicago/Turabian Style

Sainz-Bravo, Livier, Benjamín Gómez-Navarro, Diana Laura Figueroa-Gamiño, Jenniffer Topacio Tapia-Báez, José David González-Barajas, Manuel Luis Prieto-Magallanes, José Ángel Solís-Rojas, Edgar Bautista-Reyes, Juan Alberto Gómez-Fregoso, Judith Carolina De Arcos-Jiménez, and et al. 2026. "Time-Zero Kidney Biopsy and Deceased-Donor Transplant Outcomes: A Systematic Review and Meta-Analysis of Prognostic Value, Prediction, and Clinical Utility" Medical Sciences 14, no. 5: 566. https://doi.org/10.3390/medsci14050566

APA Style

Sainz-Bravo, L., Gómez-Navarro, B., Figueroa-Gamiño, D. L., Tapia-Báez, J. T., González-Barajas, J. D., Prieto-Magallanes, M. L., Solís-Rojas, J. Á., Bautista-Reyes, E., Gómez-Fregoso, J. A., Arcos-Jiménez, J. C. D., Medina-González, R., Camarena-Arteaga, V. A., Arizaga-Napoles, M., & Briseno-Ramirez, J. (2026). Time-Zero Kidney Biopsy and Deceased-Donor Transplant Outcomes: A Systematic Review and Meta-Analysis of Prognostic Value, Prediction, and Clinical Utility. Medical Sciences, 14(5), 566. https://doi.org/10.3390/medsci14050566

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