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Seven themes were selected and underwent in-depth analysis after formulation of PICO (patient\/population, intervention, comparison, outcomes) questions. After literature search, the statements for each key question were produced, rated according the GRADE approach [Quality of evidence: High (A), Moderate (B), Low (C); Strength of Recommendation: Strong (1), Weak (2)]. The statements were subsequently presented in-person at the Prague kick-off meeting, discussed and voted. After two rounds of discussion and voting, all 7 statements reached an overall agreement of 100% on the following issues: needle core\/wedge\/punch technique representatively [B,1], frozen\/paraffin embedded section reliability [B,2], experienced\/non-experienced on-call renal pathologist reproducibility\/accuracy of the histological report [A,1], glomerulosclerosis\/other parameters reproducibility [C,2], digital pathology\/light microscopy in the measurement of histological variables [A,1], special stainings\/Haematoxylin and Eosin alone comparison [A,1], glomerulosclerosis reliability <jats:italic>versus<\/jats:italic> other histological parameters to predict the graft survival, graft function, primary non-function [B,1]. This methodology has allowed to reach a full consensus among European experts on important technical topics regarding pre-implantation biopsy in the ECD graft assessment.<\/jats:p>","DOI":"10.3389\/ti.2023.11410","type":"journal-article","created":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T14:53:59Z","timestamp":1688482439000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":17,"title":["European Society for Organ Transplantation (ESOT)-TLJ 3.0 Consensus on Histopathological Analysis of Pre-Implantation Donor Kidney Biopsy: Redefining the Role in the Process of Graft Assessment"],"prefix":"10.3389","volume":"36","author":[{"given":"Gianluigi","family":"Zaza","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cucchiari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Ulrich","family":"Becker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiko P. 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