{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:06:14Z","timestamp":1790071574230,"version":"4.0.1"},"reference-count":258,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med. Sci.","Medical Sciences"],"abstract":"<jats:p>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\u2013Knapp 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\u20133.06), glomerulosclerosis with graft failure (hazard ratio: 2.03, 1.22\u20133.39) and vascular injury with graft failure (hazard ratio: 1.48, 1.07\u20132.04); glomerulosclerosis with delayed graft function was inconclusive (odds ratio: 1.13, 0.59\u20132.17). 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.<\/jats:p>","DOI":"10.3390\/medsci14050566","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:19:41Z","timestamp":1789381181000},"page":"566","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Time-Zero Kidney Biopsy and Deceased-Donor Transplant Outcomes: A Systematic Review and Meta-Analysis of Prognostic Value, Prediction, and Clinical Utility"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7310-3399","authenticated-orcid":false,"given":"Livier","family":"Sainz-Bravo","sequence":"first","affiliation":[{"name":"Hospital Civil de Oriente, Tonal\u00e1 45425, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3551-6106","authenticated-orcid":false,"given":"Benjam\u00edn","family":"G\u00f3mez-Navarro","sequence":"additional","affiliation":[{"name":"Consejo Estatal de Trasplantes de Jalisco (CETRAJAL), Guadalajara 45177, Mexico"},{"name":"Centro M\u00e9dico Puerta de Hierro Norte, Zapopan 45116, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8776-4665","authenticated-orcid":false,"given":"Diana Laura","family":"Figueroa-Gami\u00f1o","sequence":"additional","affiliation":[{"name":"Hospital Ju\u00e1rez de M\u00e9xico, Mexico City 07760, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3674-0761","authenticated-orcid":false,"given":"Jenniffer Topacio","family":"Tapia-B\u00e1ez","sequence":"additional","affiliation":[{"name":"Hospital General de M\u00e9xico \u201cDr. Eduardo Liceaga\u201d, Mexico City 06720, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1977-5960","authenticated-orcid":false,"given":"Jos\u00e9 David","family":"Gonz\u00e1lez-Barajas","sequence":"additional","affiliation":[{"name":"Hospital Civil de Oriente, Tonal\u00e1 45425, Mexico"},{"name":"Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2518-4741","authenticated-orcid":false,"given":"Manuel Luis","family":"Prieto-Magallanes","sequence":"additional","affiliation":[{"name":"Hospital Civil de Oriente, Tonal\u00e1 45425, Mexico"},{"name":"Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco 45641, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1087-3736","authenticated-orcid":false,"given":"Jos\u00e9 \u00c1ngel","family":"Sol\u00eds-Rojas","sequence":"additional","affiliation":[{"name":"Hospital Regional de Alta Especialidad del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Acapulco 39850, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5508-8326","authenticated-orcid":false,"given":"Edgar","family":"Bautista-Reyes","sequence":"additional","affiliation":[{"name":"Centro M\u00e9dico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City 03229, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4079-6026","authenticated-orcid":false,"given":"Juan Alberto","family":"G\u00f3mez-Fregoso","sequence":"additional","affiliation":[{"name":"Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico"},{"name":"Antiguo Hospital Civil de Guadalajara \u201cFray Antonio Alcalde\u201d, Guadalajara 44280, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0251-6425","authenticated-orcid":false,"given":"Judith Carolina","family":"De Arcos-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Hospital Civil de Oriente, Tonal\u00e1 45425, Mexico"},{"name":"Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco 45641, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7094-6964","authenticated-orcid":false,"given":"Ram\u00f3n","family":"Medina-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco 45641, Mexico"},{"name":"Antiguo Hospital Civil de Guadalajara \u201cFray Antonio Alcalde\u201d, Guadalajara 44280, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8928-6657","authenticated-orcid":false,"given":"Violeta Aidee","family":"Camarena-Arteaga","sequence":"additional","affiliation":[{"name":"Hospital Civil de Oriente, Tonal\u00e1 45425, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0488-8006","authenticated-orcid":false,"given":"Manuel","family":"Arizaga-Napoles","sequence":"additional","affiliation":[{"name":"Antiguo Hospital Civil de Guadalajara \u201cFray Antonio Alcalde\u201d, Guadalajara 44280, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1901-392X","authenticated-orcid":false,"given":"Jaime","family":"Briseno-Ramirez","sequence":"additional","affiliation":[{"name":"Hospital Civil de Oriente, Tonal\u00e1 45425, Mexico"},{"name":"Centro Universitario de Tlajomulco, Universidad de Guadalajara, Tlajomulco 45641, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1056\/NEJM199912023412303","article-title":"Comparison of Mortality in All Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric Transplant","volume":"341","author":"Wolfe","year":"1999","journal-title":"N. 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