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Kidney Week

Abstract: SA-OR104

18F-FDG PET/CT Imaging at 3 Months Post Transplantation Disproves Subclinical Rejection in Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Hanssen, Oriane, University of Liège Hospital (ULiège CHU), Liège, Belgium
  • Weekers, Laurent E., University of Liège Hospital (ULiège CHU), Liège, Belgium
  • Lovinfosse, Pierre, University of Liège Hospital (ULiège CHU), Liège, Belgium
  • Jadoul, Alexandre, University of Liège Hospital (ULiège CHU), Liège, Belgium
  • Huynen, Alexandre, University of Liège, Liège, Belgium
  • Bonvoisin, Catherine, University of Liège Hospital (ULiège CHU), Liège, Belgium
  • Bouquegneau, Antoine, University of Liège Hospital (ULiège CHU), Liège, Belgium
  • Hustinx, Roland, University of Liège Hospital (ULiège CHU), Liège, Belgium
  • Jouret, Francois, University of Liège Hospital (ULiège CHU), Liège, Belgium

Subclinical kidney allograft acute rejection (SCR) corresponds to “the histological documentation of unexpected evidence of acute rejection (AR) in a stable patient”. SCR detection relies on surveillance biopsy. Still, non-invasive approaches may help avoid biopsy-associated complications and limitations. Positron emission tomography (PET) coupled with computed tomography (CT) after injection of F18-fluorodeoxyglucose (18F-FDG) may be an option.


From 11/2015 to 01/2018, we prospectively performed 18F-FDG-PET/CT in adult kidney transplant recipients (KTR) who underwent surveillance transplant biopsy at ~3 months post transplantation. Banff-2017 classification was used. The ratio of the mean standard uptake value (mSUVR) between kidney graft cortex and psoas muscle was measured. One-way analysis of variance (ANOVA) followed by Student t-tests was performed using the Python library SciPy to compare mSUVR among groups. Additionally, the R-squared statistic assessed the correlation between mSUVR and acute composite Banff score or total inflammation. Finally, the receiver operating characteristic (ROC) curve was built using Python programming language.


In our 95-patient cohort, the median age of recipients was 57 years [min 37; max 68], with a gender ratio (M/F) of 2 and a mean BMI of 27±5kg kg/m2. The cohort was categorized into 3 groups upon Banff-based histology: normal (n=70); borderline (n=16); AR (n=6). Three cases were excluded for PCR-proven BK nephropathy (n=2) or uninterpretable histology (n=1). No clinical or biological difference was observed between groups. The mSUVR reached 1.87±0.55, 1.94±0.35 and 2.41±0.54 in normal, borderline and AR groups, respectively. A significant difference of mSUVR was found among groups. Furthermore, mSUVR was significantly higher in AR versus normal (p, 0.02) or borderline (p, 0.02) groups. The area under the ROC curve (AUC) was 0.79, with 83% sensitivity and 87% specificity using mSUVR threshold at 2.4. The mSUVR positively correlated with total-i (r 2=0.05; p, 0.02) and acute composite Banff score (r2=0.04; p, 0.05).


18F-FDG-PET/CT imaging helps non-invasively detect SCR, with a negative predictive value of 98% using 2.4 as mSUVR threshold.


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