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Utility and Cost-effectiveness of Surveillance Biopsies
Deeptanshu Jain1, Parmjeet S Randhawa2,3, Chethan M Puttarajappa1,3
1Renal-Electrolyte Division, Department of Medicine.
Current Opinion in Organ Transplantation
|June 8, 2026
Summary
Surveillance biopsies in kidney transplantation are less effective due to modern immunosuppression. A risk-stratified approach using biomarkers is recommended for efficient monitoring and cost savings.
Area of Science:
- Nephrology
- Transplantation Immunology
- Clinical Pathology
Background:
- The utility of surveillance biopsies in kidney transplantation is debated amidst advancements in immunosuppression and diagnostics.
- Historical roles of protocol biopsies are challenged by evolving donor/recipient factors and new therapies.
Purpose of the Study:
- To review the effectiveness and cost-effectiveness of surveillance biopsies in kidney transplantation.
- To propose a framework for pragmatic clinical use of surveillance biopsies.
Main Methods:
- Review of current literature on surveillance biopsies in kidney transplantation.
- Analysis of decision-analytic models for cost-effectiveness.
- Evaluation of emerging non-invasive biomarkers.
Main Results:
- Subclinical rejection prevalence has decreased with modern immunosuppression.
- Detected lesions often represent mild rejection or inflammation with uncertain treatment benefits.
- Biopsies still detect chronic injury, donor-derived disease, and recurrent kidney diseases.
Conclusions:
- Routine surveillance biopsies for all kidney transplant recipients are not the most efficient strategy.
- A risk-stratified approach integrating clinical and immunological factors is optimal.
- Selective use of biomarkers alongside clinical assessment can improve monitoring and reduce costs.
