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Peer-reviewedCC BY 4.0PLOS One

A multicenter prospective validation cohort does not support the use of kidney/psoas [¹⁸F]FDG uptake in the diagnosis of kidney allograft subclinical rejection

  • Pierre Lovinfosse1
  • Antoine Bouquegneau2
  • Annick Massart3
  • Lissa Pipeleers4
  • Catherine Bonvoisin5
  • Laurens Carp6
  • Hendrik Everaert7
  • Alexandre Jadoul8
  • Amélie Dendooven9
  • Caroline Geers10
  • Stéphanie Grosch11
  • Pauline Erpicum12
5 more authors
  • Rachel Hellemans13
  • Laurence Seidel14
  • Laurent Weekers15
  • Roland Hustinx
  • François Jouret
15 affiliations
  1. 1Division of Nuclear Medicine, Department of Medical Physics, University of Liège Hospital, Liège, Belgium
  2. 2GIGA Institute, in vivo Imaging, Liège, Belgium
  3. 3Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium
  4. 4GIGA Institute, Metabolism & Cardiovascular Biology, University of Liège, Liège, Belgium
  5. 5Division of Nephrology, Department of Internal Medicine, Universitair Ziekenhuis Antwerpen, Antwerp, Belgium
  6. 6Department of Nephrology and Arterial Hypertension, Universitair Ziekenhuis Brussel, Vrije Universiteit, Brussels, Belgium
  7. 7Kidney Diseases, Dialysis & Transplantation Research Unit (NIER), Vitality Research Group, Vrije Universiteit, Brussels, Belgium
  8. 8Division of Nuclear Medicine, Universitair Ziekenhuis Antwerpen, Antwerp, Belgium
  9. 9Division of Nuclear Medicine, Department of Medical Physics, Universitair Ziekenhuis Brussel, Brussels, Belgium
  10. 10Faculty of Health Sciences, University of Antwerp, Antwerp, Belgium
  11. 11Department of Pathology, university Hospital of Ghent, Ghent, Belgium
  12. 12Division of Renal Pathology, Universitair Ziekenhuis Brussel, Brussels, Belgium
  13. 13Division of Renal Pathology, Unilab, University of Liège Hospital, Liège, Belgium
  14. 14Faculty of Medicine and Health Sciences, Laboratory of Experimental Medicine and Paediatrics, Wilrijk, Belgium
  15. 15B-STAT, University of Liège Hospital, Liège, Belgium
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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.

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Cite

BibTeXRIS
BibTeX
@article{lovinfosse2026multicenter,
  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}},
  author = {Pierre Lovinfosse and Antoine Bouquegneau and Annick Massart and Lissa Pipeleers and Catherine Bonvoisin and Laurens Carp and Hendrik Everaert and Alexandre Jadoul and Amélie Dendooven and Caroline Geers and Stéphanie Grosch and Pauline Erpicum and Rachel Hellemans and Laurence Seidel and Laurent Weekers and Roland Hustinx and François Jouret},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0345426},
  url = {https://doi.org/10.1371/journal.pone.0345426},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - A multicenter prospective validation cohort does not support the use of kidney/psoas [¹⁸F]FDG uptake in the diagnosis of kidney allograft subclinical rejection
AU  - Pierre Lovinfosse
AU  - Antoine Bouquegneau
AU  - Annick Massart
AU  - Lissa Pipeleers
AU  - Catherine Bonvoisin
AU  - Laurens Carp
AU  - Hendrik Everaert
AU  - Alexandre Jadoul
AU  - Amélie Dendooven
AU  - Caroline Geers
AU  - Stéphanie Grosch
AU  - Pauline Erpicum
AU  - Rachel Hellemans
AU  - Laurence Seidel
AU  - Laurent Weekers
AU  - Roland Hustinx
AU  - François Jouret
PY  - 2026
DA  - 2026/09/02
JO  - PLOS One
DO  - 10.1371/journal.pone.0345426
UR  - https://doi.org/10.1371/journal.pone.0345426
AB  - 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.
SN  - 1932-6203
ER  -