Skip to main content
SpringerLink
Log in

[18F]FDG PET/CT imaging disproves renal allograft acute rejection in kidney transplant recipients with acute kidney dysfunction: a validation cohort

  • Short Communication
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

[18F]FDG PET/CT may predict the absence of acute allograft rejection (AR) in kidney transplant recipients (KTRs) with acute kidney injury (AKI). Still, the proposed threshold of 1.6 of the mean of mean standardized uptake values (mSUVmean) in the renal parenchyma needs validation.

Methods

We prospectively performed 86 [18F]FDG PET/CT in 79 adult KTRs who underwent per-cause transplant biopsy for suspected AR. Biopsy-proven polyoma BK nephropathies (n = 7) were excluded. PET/CT was performed 192 ± 18 min after administration of 254.4 ± 30.4 MBq of [18F]FDG. The SUVmean was measured in both upper and lower poles of the renal allograft. One-way analysis of variance (ANOVA) and Tukey’s studentized range test were sequentially performed. The receiver operating characteristic (ROC) curve was drawn to discriminate “AR” from non-pathological (“normal” + “borderline”) conditions.

Results

The median age of the cohort was 55 [43; 63] years, with M/F gender ratio of 47/39. The mean eGFR was 31.9 ± 14.6 ml/min/1.73m2. Biopsies were categorized in 4 groups: “normal” (n = 54), “borderline” (n = 9), “AR” (n = 14), or “others” (n = 2). The median [min; max] mSUVmean reached 1.72 [1.02; 2.07], 1.97 [1.55; 2.11], 2.13 [1.65, 3.12], and 1.84 [1.57; 2.12] in “normal,” “borderline,” “AR,” and “others” groups, respectively. ANOVA demonstrated a significant difference of mSUVmean among groups (F = 13.25, p < 0.0001). The ROC area under the curve was 0.86. Test sensitivity and specificity corresponding to the threshold value of 1.6 were 100% and 30%, respectively.

Conclusion

[18F]FDG PET/CT may help noninvasively prevent inessential transplant biopsies in KTR with AKI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Data availability

The data will be made available on request.

Code availability

N/A.

References

  1. Loupy A, Haas M, Roufosse C, et al. The Banff 2019 Kidney Meeting Report (I): updates on and clarification of criteria for T cell- and antibody-mediated rejection. Am J Transplant. 2020;20:2318–31.

    Article  CAS  Google Scholar 

  2. Paquot F, Weekers L, Bonvoisin C, Pottel H, Jouret F. “Acute kidney dysfunction with no rejection” is associated with poor renal outcomes at 2 years post kidney transplantation. BMC Nephrol. 2019;20:249.

    Article  Google Scholar 

  3. Hanssen O, Erpicum P, Lovinfosse P, et al. Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients. Part I. In vivo imaging methods. Clin Kidney J. 2017;10:97–105.

    PubMed  CAS  Google Scholar 

  4. Erpicum P, Hanssen O, Weekers L, et al. Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients, part II: omics analyses of urine and blood samples. Clin Kidney J. 2017;10:106–15.

    PubMed  CAS  Google Scholar 

  5. Tinel C, Devresse A, Vermorel A, et al. Development and validation of an optimized integrative model using urinary chemokines for noninvasive diagnosis of acute allograft rejection. Am J Transplant. 2020;20:3462–76.

    Article  CAS  Google Scholar 

  6. Reuter S, Schnockel U, Schroter R, et al. Non-invasive imaging of acute renal allograft rejection in rats using small animal F-FDG-PET. PLoS One. 2009;4:e5296.

    Article  CAS  Google Scholar 

  7. Lovinfosse P, Weekers L, Bonvoisin C, et al. Fluorodeoxyglucose F(18) positron emission tomography coupled with computed tomography in suspected acute renal allograft rejection. Am J Transplant. 2016;16:310–6.

    Article  CAS  Google Scholar 

  8. Jadoul A, Lovinfosse P, Weekers L, et al. The Uptake of 18F-FDG by Renal Allograft in Kidney Transplant Recipients Is Not Influenced by Renal Function. Clin Nucl Med. 2016;41:683–7.

    Article  Google Scholar 

  9. Costa C, Cavallo R. Polyomavirus-associated nephropathy. World J Transplant. 2012;2:84–94.

    Article  Google Scholar 

  10. Lovinfosse P, Hustinx R. Nuclear medicine techniques in transplantation. Clin Transl Imaging. 2017;5:45–62.

    Article  Google Scholar 

Download references

Acknowledgements

The authors cordially thank the surgeons (C. Coimbra Marques, A. De Roover, O. Detry, E. Hamoir, P. Honoré, L. Kohnen, N. Meurisse, and J-P Squifflet), the physicians (P. Erpicum, O. Hanssen, L. Vanovermeire, and P. Xhignesse), and the members of the local transplant coordination center (M-H. Delbouille, J. Monard, S. Princen, and A. Waromes), as well as the staff of the Division of Nuclear Medicine of the University of Liège Hospital in Liège, Belgium. FJ is a Fellow of the Fonds National de la Recherche Scientifique and received support from the University of Liège (Fonds Spéciaux à la Recherche) and from the Fondation Léon Fredericq.

Funding

FJ is a Fellow of the Fonds National de la Recherche Scientifique and received support from the University of Liège (Fonds Spéciaux à la Recherche) and from the Fondation Léon Fredericq.

Author information

Author notes

  1. P. Lovinfosse and L. Weekers contributed equally to this work.

Authors and Affiliations

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

    P. Lovinfosse & R. Hustinx

  2. Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium

    L. Weekers, A. Bouquegneau, C. Bonvoisin, C. Bovy, S. Grosch & Francois Jouret

  3. Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium

    H. Pottel

  4. Division of Renal Pathology, Unilab, University of Liège Hospital (ULg CHU), Liège, Belgium

    C. Bovy & S. Grosch

  5. GIGA CRC in Vivo Imaging, University of Liège, Liège, Belgium

    R. Hustinx

  6. Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of Liège, Liège, Belgium

    Francois Jouret

Authors
  1. P. Lovinfosse
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Weekers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Pottel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Bouquegneau
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Bonvoisin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Bovy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Grosch
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R. Hustinx
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francois Jouret
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LP, LW, RH, and FJ designed the study; RH and FJ secured the funding of the study; HP performed the statistical analyses; LW, AB, and CB recruited the patients and filled the medical files; AB performed the kidney biopsies; CB and SG scored the biopsies; LP and RH scored the [18F]FDG PET/CT images; LP and FJ wrote the manuscript; all authors approved the final version of the manuscript.

Corresponding author

Correspondence to Francois Jouret.

Ethics declarations

Ethics approval

The study was approved by the institutional review board of the ULiège Academic Hospital (#B707201215598).

Consent to participate

After written informed consent, adult KTRs undergoing a transplant biopsy for suspected AR were prospectively enrolled between March 2015 and December 2019.

Conflicts of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Infection and inflammation

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lovinfosse, P., Weekers, L., Pottel, H. et al. [18F]FDG PET/CT imaging disproves renal allograft acute rejection in kidney transplant recipients with acute kidney dysfunction: a validation cohort. Eur J Nucl Med Mol Imaging 49, 331–335 (2021). https://doi.org/10.1007/s00259-021-05467-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-021-05467-0

Keywords

Search

Navigation