ArticlePloS one2026
A multicenter prospective validation cohort does not support the use of kidney/psoas [18F]FDG uptake in the diagnosis of kidney allograft subclinical rejection.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSubclinical kidney allograft acute rejection (SCR) corresponds to "the unexpected histological evidence of acute rejection in a stable patient". The diagnosis of SCR relies on surveillance biopsy. Positron emission tomography (PET/CT) after injection of F18-fluorodeoxyglucose ([18F]FDG) has been proposed as a non-invasive screening approach. In the present multicenter prospective study, we assess the diagnostic yield [18F]FDGPET/CT to rule out SCR in stable KTR at 3 months post KTx.
methodsFrom 01/2021-03/2025, we prospectively combined surveillance biopsy and [18F]FDGPET/CT at ~3 months post transplantation in adult kidney transplant recipients from 4 independent imaging centers. The mean standardized uptake value (mSUV) was measured in kidney cortex and referenced as a ratio to psoas muscle mSUV (mSUVR).
resultsOur multicenter cohort of 185 patients was categorized according to the Banff-2022 classification as: normal (n = 158); borderline (n = 18); SCR (n = 9, including 6 T-cell-mediated rejection and 3 microvascular inflammation). No significant correlation was observed between the mSUVR and ti score (R = 0.032, p-value = 0.67). The mSUVR reached 2.33 [1.97-2.93], 2.71 [2.50-3.33] and 2.42 [2.27-3.14] in normal, borderline and SCR groups, respectively. In multivariate models stratified by center, the risk of non-normal histology (n = 27, including borderline and SCR) increased with donor age (OR=1.05 [1.01-1.1], p = 0.02) but not with the mSUVR (OR=4.11 [0.91-18.48], p = 0.07). The Z-score of mSUVR was significantly associated with the risk of non-normal histology (OR=1.542 [1.02-2.33, p = 0.04). The risk of biopsy-proven SCR (n = 9) was not significantly associated with mSUVR.
conclusionsThe mSUVR of [18F]FDG PET/CT does not reliably rule out SCR on surveillance biopsy.
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