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Nuclear medicine techniques in transplantation

  • Review Article
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Clinical and Translational Imaging Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the indications and perspectives of nuclear medicine techniques in transplantation.

Methods

We performed a systematic review of the literature using PubMed/Medline and Google scholars, with multiple research keywords for each organ accompanying the terms “transplant”, “transplantation”, “graft”, “nuclear imaging”, “scintigraphy”, “PET” and “PET/CT”. The review considers the following organs/systems: kidney, liver, pancreas, heart, lung, bone and salivary glands, as well as a common complication, the post-transplant lymphoproliferative disorder. The references of the retrieved articles were also considered to find supplementary articles. The search was limited to English language. Preoperative workup exploration, preclinical and animal studies were not included in the review. A total of 146 original articles were considered for the review, including 118 retrospective and 28 prospective studies.

Results

The functional integrity of the renal graft is safely and reliably assessed using quantitative dynamic scintigraphy with 99mTc-DTPA or 99mTc-MAG3. 18F-FDG PET/CT is a promising method for early detection of acute rejection. The glomerular filtration rate (GFR) of potential donors should ideally be assessed using 51Cr-EDTA, and the split renal function could be quantified using 99mTc-MAG3 or 99mTc-DMSA imaging. In liver transplantation, both 99mTc-GSA and 99mTc-HIDA scintigraphies can be used for evaluating the function of transplanted liver, and 18F-FDG PET/CT increasingly appears as a powerful tool for characterising the aggressiveness of hepatocellular carcinoma and contributes to the decision of transplantation in selected patients. In heart transplants, the major indication is the evaluation of cardiac allograft vasculopathy using myocardial perfusion imaging, either with SPECT or PET. In the context of lung transplantation, perfusion scanning helps select potential donors and contributes to the postoperative follow-up, either early on for detecting primary graft dysfunction or later on in the diagnosis of chronic rejection. Bone scintigraphy and 18F-NaF PET/CT are valuable tools for assessing bone graft viability. This is particularly established in mandible grafts, but convincing data are available in other types of graft. Salivary gland transplantation is not frequently performed, but in such a clinical situation, 99mTcO4 scintigraphy is an elegant way to help select the transplant and to verify the viability of the graft. Finally, 18F-FDG PET/CT is very effective in patients with post-transplant lymphoproliferative disorder (PTLD), both at diagnosis and for evaluating the response to treatment.

Conclusion

Nuclear medicine techniques are strongly established as valuable clinical tools in a wide variety of indications, before and after organ transplantation. Furthermore, 18F-FDG PET/CT in PTLD and radio-isotopic evaluation of the renal function in putative kidney donors are recommended in clinical algorithms proposed in international guidelines.

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Fig. 1

Reprinted from [31], with permission

Fig. 2
Fig. 3

Reprinted from [173], with permission from Annals of Nuclear Medicine

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  1. Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium

    Pierre Lovinfosse & Roland Hustinx

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  1. Pierre Lovinfosse
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  2. Roland Hustinx
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Lovinfosse, P., Hustinx, R. Nuclear medicine techniques in transplantation. Clin Transl Imaging 5, 45–62 (2017). https://doi.org/10.1007/s40336-016-0216-5

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