{ "abstract": "Background: Subclinical 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. Methods: From 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). Results: Our 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. Conclusions: The mSUVR of [18F]FDG PET/CT does not reliably rule out SCR on surveillance biopsy.", "abstract_shown": true, "affiliations": [ "Division of Nuclear Medicine, Department of Medical Physics, University of Liège Hospital, Liège, Belgium", "GIGA Institute, in vivo Imaging, Liège, Belgium", "Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium", "GIGA Institute, Metabolism & Cardiovascular Biology, University of Liège, Liège, Belgium", "Division of Nephrology, Department of Internal Medicine, Universitair Ziekenhuis Antwerpen, Antwerp, Belgium", "Department of Nephrology and Arterial Hypertension, Universitair Ziekenhuis Brussel, Vrije Universiteit, Brussels, Belgium", "Kidney Diseases, Dialysis & Transplantation Research Unit (NIER), Vitality Research Group, Vrije Universiteit, Brussels, Belgium", "Division of Nuclear Medicine, Universitair Ziekenhuis Antwerpen, Antwerp, Belgium", "Division of Nuclear Medicine, Department of Medical Physics, Universitair Ziekenhuis Brussel, Brussels, Belgium", "Faculty of Health Sciences, University of Antwerp, Antwerp, Belgium", "Department of Pathology, university Hospital of Ghent, Ghent, Belgium", "Division of Renal Pathology, Universitair Ziekenhuis Brussel, Brussels, Belgium", "Division of Renal Pathology, Unilab, University of Liège Hospital, Liège, Belgium", "Faculty of Medicine and Health Sciences, Laboratory of Experimental Medicine and Paediatrics, Wilrijk, Belgium", "B-STAT, University of Liège Hospital, Liège, Belgium" ], "article_type": "Research Article", "arxiv": null, "author_total": 17, "authors": [ { "affs": [ 0 ], "name": "Pierre Lovinfosse" }, { "affs": [ 1 ], "name": "Antoine Bouquegneau" }, { "affs": [ 2 ], "name": "Annick Massart" }, { "affs": [ 3 ], "name": "Lissa Pipeleers" }, { "affs": [ 4 ], "name": "Catherine Bonvoisin" }, { "affs": [ 5 ], "name": "Laurens Carp" }, { "affs": [ 6 ], "name": "Hendrik Everaert" }, { "affs": [ 7 ], "name": "Alexandre Jadoul" }, { "affs": [ 8 ], "name": "Amélie Dendooven" }, { "affs": [ 9 ], "name": "Caroline Geers" }, { "affs": [ 10 ], "name": "Stéphanie Grosch" }, { "affs": [ 11 ], "name": "Pauline Erpicum" }, { "affs": [ 12 ], "name": "Rachel Hellemans" }, { "affs": [ 13 ], "name": "Laurence Seidel" }, { "affs": [ 14 ], "name": "Laurent Weekers" }, { "name": "Roland Hustinx" }, { "name": "François Jouret" } ], "bibtex": "https://research.draconitic.com/paper/b8rtnb69bms9c.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0345426", "fulltext_url": null, "id": "b8rtnb69bms9c", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0345426", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2747|Renal Transplantation Outcomes and Treatments" ], [ "plos", "/Biology and life sciences/Anatomy/Histology" ], [ "plos", "/Biology and life sciences/Anatomy/Renal system/Kidneys" ], [ "plos", "/Biology and life sciences/Immunology/Immune response/Inflammation" ], [ "plos", "/Biology and life sciences/Neuroscience/Neuroimaging/Computed axial tomography" ], [ "plos", "/Biology and life sciences/Neuroscience/Neuroimaging/Positron emission tomography" ], [ "plos", "/Medicine and health sciences/Anatomy/Histology" ], [ "plos", "/Medicine and health sciences/Anatomy/Renal system/Kidneys" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Inflammation" ], [ "plos", "/Medicine and health sciences/Diagnostic medicine/Diagnostic radiology/Tomography/Computed axial tomography" ], [ "plos", "/Medicine and health sciences/Diagnostic medicine/Diagnostic radiology/Tomography/Positron emission tomography" ], [ "plos", "/Medicine and health sciences/Epidemiology/Medical risk factors" ], [ "plos", "/Medicine and health sciences/Immunology/Immune response/Inflammation" ], [ "plos", "/Medicine and health sciences/Radiology and imaging/Diagnostic radiology/Tomography/Computed axial tomography" ], [ "plos", "/Medicine and health sciences/Radiology and imaging/Diagnostic radiology/Tomography/Positron emission tomography" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures/Biopsy" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures/Transplantation/Organ transplantation/Renal transplantation" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures/Urinary system procedures/Renal transplantation" ], [ "plos", "/Research and analysis methods/Imaging techniques/Diagnostic radiology/Tomography/Computed axial tomography" ], [ "plos", "/Research and analysis methods/Imaging techniques/Diagnostic radiology/Tomography/Positron emission tomography" ], [ "plos", "/Research and analysis methods/Imaging techniques/Neuroimaging/Computed axial tomography" ], [ "plos", "/Research and analysis methods/Imaging techniques/Neuroimaging/Positron emission tomography" ] ], "openalex": "W7206189764", "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0345426&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-02", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/b8rtnb69bms9c.ris", "sources": [ { "first_seen": "2026-10-30T12:18:02Z", "native_id": "10.1371/journal.pone.0345426", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0345426" } ], "subjects": [ { "field": "medicine", "origin": "plos:diagnostic radiology", "subfield": "imaging" }, { "field": "medicine", "origin": "plos:anatomy", "subfield": "physiology" }, { "field": "medicine", "origin": "plos:surgical and invasive medical procedures", "subfield": "surgery" } ], "title": "A multicenter prospective validation cohort does not support the use of kidney/psoas [¹⁸F]FDG uptake in the diagnosis of kidney allograft subclinical rejection", "title_text": "A multicenter prospective validation cohort does not support the use of kidney/psoas [¹⁸F]FDG uptake in the diagnosis of kidney allograft subclinical rejection", "type": "peer-reviewed", "updated_at": "2026-10-30T12:18:02Z", "url": "https://research.draconitic.com/paper/b8rtnb69bms9c", "venue": "PLOS One", "versions": [] }