Publication Name	World Journal of Transplantation
Manuscript ID	118088
Country	United States

Category	Transplantation
Manuscript Type	Retrospective Study
Article Title	Rethinking procurement biopsy in donors with normal renal function: A barrier to kidney utilization without survival benefit
Manuscript Source	Invited Manuscript
All Author List	Lena Sibulesky, Daniel M Kaufman, Ramasamy Bakthavatsalam, Nicolae Leca and James D Perkins
Funding Agency and Grant Number
Corresponding Author	Lena Sibulesky, Associate Professor, MD, Division of Transplant Surgery, Department of Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195, United States. lenasi@uw.edu
Key Words	Kidney transplant; Procurement biopsy; Death-censored graft survival; Donor kidney discard; Renal function
Core Tip	Using national Organ Procurement and Transplantation Network data, we show that procurement biopsy in deceased donors with preserved renal function does not improve prognostic accuracy or graft survival. Instead, biopsy is associated with substantially higher discard rates and prolonged cold ischemia, with much of its adverse impact mediated through ischemic delay and early graft dysfunction. Advanced analytic approaches, including mediation, restricted mean survival time, and decision-curve analyses, demonstrate no added clinical benefit beyond standard donor and recipient characteristics. These findings challenge routine procurement biopsy in this donor population and support re-evaluating biopsy-driven acceptance practices to improve kidney utilization.
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; In press

Received	2025-12-23 08:40
Peer-Review Started	2025-12-23 08:40
First Decision by Editorial Office Director	2025-12-29 09:13
Return for Revision	2025-12-29 09:13
Revised	2026-01-05 20:22
Publication Fee Transferred
Second Decision by Editor	2026-02-14 02:35
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-02-14 09:50
Articles in Press	2026-02-14 09:50
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	2220-3230 (online)
Open Access	This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Copyright	© The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
Permissions	For details, please visit: http://www.wjgnet.com/bpg/gerinfo/207
Publisher	Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Website	http://www.wjgnet.com