Rethinking procurement biopsy in donors with normal renal function: A barrier to kidney utilization without survival benefit

doi:10.5500/wjt.v16.i2.118088

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Transplant. Jun 18, 2026; 16(2): 118088
Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.118088

Table 4 Comparison of donor and recipient characteristics between biopsied and non-biopsied kidneys, n (%)/median (interquartile rage)

Characteristics	Not biopsied (n = 66057)	Biopsied (n = 51450)	P value¹
Donor
Kidney			< 0.001
Dual/en bloc	1846 (2.8)	632 (1.2)
Left	29520 (44.7)	25037 (48.7)
Right	34691 (52.5)	25781 (50.1)
Age, years	31 (21-41)	51 (41-58)	< 0.001
Male	42927 (65.0)	31246 (60.7)	< 0.001
Blood type			< 0.001
A	24178 (36.6)	19457 (37.8)
AB	2437 (3.7)	1701 (3.3)
B	7437 (11.3)	5899 (11.5)
O	32005 (48.5)	24393 (47.4)
Height, cm	172 (163-179)	170 (164-178)	< 0.001
Weight, kg	76.5 (63.5-90.6)	83.0 (70-99.2)	< 0.001
History of hypertension	8080 (12.2)	23896 (46.5)	< 0.001
Diabetes mellitus	1277 (1.9)	7922 (15.4)	< 0.001
DCD	16099 (24.4)	22600 (43.9)	< 0.001
COD: CVA/stroke	9303 (14.1)	16890 (32.8)	< 0.001
eGFR terminal	115.6 (93.9-130.6)	102.3 (82.2-114.0)	< 0.001
KDRI	1.01 (0.89-1.17)	1.37 (1.16-1.59)	< 0.001
Recipient
Age, years	47 (35-59)	59 (50-66)	< 0.001
Male	37986 (57.5)	31525 (61.3)	< 0.001
Height, cm	168 (160-178)	170 (163-178)	< 0.001
Weight, kg	78.0 (64.0-93.3)	81.6 (69.0-95.3)	< 0.001
Diagnosis			< 0.001
Autoimmune/systemic	3122 (4.7)	1503 (2.9)
Cystic/genetic	5311 (8.0)	3903 (7.6)
Diabetes mellitus	13250 (20.1%	18007 (35.0)
Glomerular	10890 (16.5)	5992 (11.7)
Other	9943 (15.1)	5227 (10.2)
Retransplant	9595 (14.5)	5185 (10.1)
Vascular/hypertensive	13946 (21.1)	11633 (22.6)
cPRA	2.3 (0-72.3)	0 (0-48)	< 0.001
Peripheral vascular disease	6003 (9.1)	7108 (13.8)	< 0.001
Dialysis groups			< 0.001
Preemptive	6881 (10.4)	5059 (9.8)
≤ 1 year	5579 (8.5)	3690 (7.2)
> 1 year ≤ 3 years	15586 (23.6)	11935 (23.2)
> 3 years ≤ 5 years	14268 (21.6)	12275 (23.9)
> 5 years	23743 (35.9)	18492 (35.9)
Wait list, days	479 (121-1240)	535 (128-1305)	< 0.001
EPTS, %	33 (13-68)	62 (35-83)	< 0.001
Transplant
Year of transplant			< 0.001
2014-2019	29559 (44.7)	21139 (41.1)
2020-2024	36498 (55.3)	30311 (58.9)
HLA mismatches			< 0.001
0	3394 (5.1)	2542 (4.9)
1-2	4734 (7.2)	2937 (5.7)
3-4	28145 (42.6)	21267 (41.3)
5-6	29784 (45.1)	24704 (48.0)
Machine perfusion	19375 (29.3)	32399 (63.0)	< 0.001
Cold ischemia time, hours	16.5 (11.5-21.6)	19.5 (15.0-24.0)	< 0.001
Distance donor to transplant hospital, miles	88 (13-203)	97 (16-212)	< 0.001
Shared organ			< 0.001
Local	39177 (59.3)	28868 (56.1)
Regional	11703 (17.7)	10630 (20.7)
National	15177 (23.0)	11952 (23.2)

¹Categorical variables were compared using χ² or Fisher’s exact test, as appropriate. Continuous variables were compared using the Wilcoxon rank-sum test.

DCD: Donor after circulatory death; COD: Cause of death; CVA: Cerebrovascular accident; eGFR: Epidermal growth factor receptor; KDRI: Kidney Donor Risk Index; cPRA: Calculated panel reactive antibody; EPTS: Estimated post-transplant survival; HLA: Human leukocyte antigen.

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Citation: Sibulesky L, Kaufman DM, Bakthavatsalam R, Leca N, Perkins JD. Rethinking procurement biopsy in donors with normal renal function: A barrier to kidney utilization without survival benefit. World J Transplant 2026; 16(2): 118088
URL: https://www.wjgnet.com/2220-3230/full/v16/i2/118088.htm
DOI: https://dx.doi.org/10.5500/wjt.v16.i2.118088

Sibulesky L, Kaufman DM, Bakthavatsalam R, Leca N, Perkins JD. Rethinking procurement biopsy in donors with normal renal function: A barrier to kidney utilization without survival benefit. World J Transplant 2026; 16(2): 118088 [PMID: 42281884 DOI: 10.5500/wjt.v16.i2.118088]

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