Nuclear medicine techniques in transplantation

Authors: Pierre Lovinfosse Roland Hustinx

Publish Date: 2016/11/21

Volume: 5, Issue: 1, Pages: 45-62

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Abstract

We performed a systematic review of the literature using PubMed/Medline and Google scholars with multiple research keywords for each organ accompanying the terms “transplant” “transplantation” “graft” “nuclear imaging” “scintigraphy” “PET” and “PET/CT” The review considers the following organs/systems kidney liver pancreas heart lung bone and salivary glands as well as a common complication the posttransplant lymphoproliferative disorder The references of the retrieved articles were also considered to find supplementary articles The search was limited to English language Preoperative workup exploration preclinical and animal studies were not included in the review A total of 146 original articles were considered for the review including 118 retrospective and 28 prospective studiesThe functional integrity of the renal graft is safely and reliably assessed using quantitative dynamic scintigraphy with 99mTcDTPA or 99mTcMAG3 18FFDG PET/CT is a promising method for early detection of acute rejection The glomerular filtration rate GFR of potential donors should ideally be assessed using 51CrEDTA and the split renal function could be quantified using 99mTcMAG3 or 99mTcDMSA imaging In liver transplantation both 99mTcGSA and 99mTcHIDA scintigraphies can be used for evaluating the function of transplanted liver and 18FFDG PET/CT increasingly appears as a powerful tool for characterising the aggressiveness of hepatocellular carcinoma and contributes to the decision of transplantation in selected patients In heart transplants the major indication is the evaluation of cardiac allograft vasculopathy using myocardial perfusion imaging either with SPECT or PET In the context of lung transplantation perfusion scanning helps select potential donors and contributes to the postoperative followup either early on for detecting primary graft dysfunction or later on in the diagnosis of chronic rejection Bone scintigraphy and 18FNaF PET/CT are valuable tools for assessing bone graft viability This is particularly established in mandible grafts but convincing data are available in other types of graft Salivary gland transplantation is not frequently performed but in such a clinical situation 99mTcO4 scintigraphy is an elegant way to help select the transplant and to verify the viability of the graft Finally 18FFDG PET/CT is very effective in patients with posttransplant lymphoproliferative disorder PTLD both at diagnosis and for evaluating the response to treatmentNuclear medicine techniques are strongly established as valuable clinical tools in a wide variety of indications before and after organ transplantation Furthermore 18FFDG PET/CT in PTLD and radioisotopic evaluation of the renal function in putative kidney donors are recommended in clinical algorithms proposed in international guidelines

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