Kidney transplantation is indeed a boon for uremic patients. Since the donor kidney received is allogeneic, the risk of rejection may exist throughout life. Once clinical symptoms appear, the transplanted kidney has already suffered serious or even irreversible damage. Transplant kidney biopsy is of great clinical importance in the early diagnosis of transplant rejection, cyclosporine poisoning, identifying the cause of abnormal transplant kidney function, determining and changing the treatment plan and predicting the long-term prognosis of the transplanted kidney. Routine renal biopsies were performed in pre-transplant donor kidneys and those with abnormal blood creatinine at 3 and 12 months post-transplantation at the PLA Nephrology Institute, Nanjing General Hospital, Nanjing Military Region, to improve the long-term survival rate of transplanted kidneys. Since cadaveric and living donor kidneys are still far from meeting clinical demand, the use of cadaveric and living donor kidneys is being further expanded so that what used to be called marginal donors, i.e., those who used to be considered unsuitable due to age and health (e.g., hypertension), are now being used for clinical transplantation. Since the age of the donor is directly related to the long-term survival of the transplanted kidney, preoperative biopsy of this group of donors is increasingly important to identify any histological lesions that may affect the long-term prognosis of the transplanted kidney, such as glomerulosclerosis and interstitial fibrosis. This is especially unfortunate if you receive a kidney with disease. The Institute of Nephrology must routinely biopsy the donor kidney before transplantation, and issue a pathology report within 2 hours. Since cadaveric donor kidneys are commonly used in China, clinicians are unable to have a full understanding of the physical condition of the donor before transplantation. Histological examination of the donor kidney reveals that about 30-40% of the donor kidneys will have donor-associated kidney injury, which mainly includes chronic kidney diseases such as IgA nephropathy, hereditary and congenital diseases, and infectious diseases (e.g. cytomegalovirus infection). In addition, this test provides a comprehensive and accurate understanding of whether the kidney was well perfused during the kidney retrieval procedure, the extent of surgical damage to the kidney, and the overall quality of the donor kidney. All of these donor-associated kidney injuries can affect the long-term prognosis of the transplanted kidney and are independent risk factors for the failure of the transplanted kidney. For example, donor glomerulosclerosis accounts for 11-20% of patients with creatinine clearance < 34 ml/min (normal value is 80-120 ml/min) at one year after transplantation, while only 25% of patients with donor glomerulosclerosis have creatinine clearance < 34 ml/min at one year after transplantation. All routine biopsies of transplanted kidneys suggest that new morphologic changes in kidney histology occur at about three months postoperatively and worsen with time in both cadaveric and living kidney transplants. In older living donor kidneys from relatives, biopsy of the donor kidney can also reveal the presence of: glomerulosclerosis, chronic nephritis, tumors, and primary kidney disease. Most importantly, the knowledge of the donor kidney provides a histological and immunological basis for the diagnosis and treatment of various post-transplant complications. Therefore, preoperative donor kidney biopsy is beneficial for the detection of potential kidney diseases in the donor kidney that are difficult to detect by conventional noninvasive examination, and facilitates targeted treatment and disease prevention in the donor and recipient after kidney transplantation, and preoperative kidney puncture biopsy pathology in the donor kidney has important reference significance for donor kidney selection.