Zero-Time Renal Transplant Biopsies: A Comprehensive Review

Area of Science:

• Nephrology
• Transplantation immunology
• Pathology

Background:

• Zero-time kidney biopsies are routinely performed at transplantation.
• Histological data from these biopsies inform critical decisions regarding kidney discard, allocation, and treatment.
• The clinical utility and predictive performance of these biopsies are subjects of ongoing evaluation.

Purpose of the Study:

• To review the practical aspects of performing zero-time kidney biopsies.
• To evaluate the predictive performance of zero-time histology and composite scores for posttransplant outcomes.
• To assess the clinical utility of zero-time biopsies in kidney transplantation.

Main Methods:

• Comprehensive literature review of studies on zero-time kidney biopsies.
• Analysis of the predictive performance of individual histological lesions and composite scores.
• Evaluation of the clinical utility in decision-making processes and research.

Main Results:

• The predictive performance of zero-time histology for posttransplant outcomes is only moderate.
• No single histological feature or composite score is robust enough for kidney discard algorithms.
• Dual kidney transplantation based on histology improves individual outcomes, but waitlist effects are unclear.

Conclusions:

• Zero-time biopsies are valuable for clinical and translational research, offering baseline data and insights into risk factors.
• Molecular phenotyping may reveal novel therapeutic targets but its predictive superiority over demographic factors is uncertain.
• Current histological assessment has limitations for guiding discard decisions, necessitating further research into predictive markers.