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Purpose <p>Rejection, especially chronic rejection is a key factor influencing the prognosis of kidney transplantation patients. While <sup>18</sup>F-fibroblast activation protein inhibitor (FAPI)-04 PET/CT has been widely utilized for diagnosing various diseases, its diagnostic efficacy in kidney transplant rejection remains unexplored.</p> Methods <p>In this study, 24 kidney transplant recipients were prospectively enrolled and divided into a control cohort and a rejection cohort (KTR), which were further classified into acute rejection (AR), mixed rejection (MR), and chronic rejection (CR) subgroups. All patients underwent <sup>18</sup>F-FAPI-04 PET/CT and <sup>18</sup>F-FDG PET/CT scans, along with immunohistochemical FAP staining and Banff pathological scoring. The maximum and average standardized uptake values (SUVs) of the two imaging methods were calculated.</p> Results <p>Compared with the control cohort, the KTR cohort showed significantly higher serum creatinine levels, lower estimated glomerular filtration rates, and lower hemoglobin levels. The SUVmax of <sup>18</sup>F-FAPI-04 PET/CT in the allograft kidney cortex (AKC) and allograft kidney biopsy site (AKB) in the KTR cohort was significantly greater than that in the control cohort. The SUVmax of <sup>18</sup>F-FDG PET/CT between the two cohorts was significantly different only in the AKC. For the KTR cohort, the SUVmax of <sup>18</sup>F-FAPI-04 PET/CT in AKC and AKB was considerably greater than that of <sup>18</sup>F-FDG PET/CT (5.5 vs. 2.8 and 3.6 vs. 2.5, respectively; both <i>p</i> &lt; 0.01). In the CR cohort, the SUVmax of <sup>18</sup>F-FAPI-04 PET/CT in the AKC, AKB, and allograft kidney medulla (AKM) was significantly greater (7.1, 5.3, and 3.2) than that of <sup>18</sup>F-FDG PET/CT (2.5, 2.1 and 1.8) (<i>p</i> = 0.009, 0.009 and 0.016, respectively). The SUVmax of <sup>18</sup>F-FAPI-04 PET/CT in AKB increased gradually in the AR, MR, and CR cohorts (2.8 vs. 3.6 vs. 5.3, <i>p</i> = 0.02). The above results were consistent with the SUVavg statistics. The number of FAP-positive stromal cells was different between the control and KTR groups and among the AR, MR, and CR subgroups.</p> Conclusion <p><sup>18</sup>F-FAPI-04 PET/CT outperforms <sup>18</sup>F-FDG PET/CT in distinguishing kidney transplant rejection, especially chronic rejection.</p>

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Noninvasive diagnosis and classification of kidney transplantation rejection by 18F-FAPI-04 PET/CT

  • 期刊论文

  • 发表日期：

    2025年5月8日

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  • Sulin Luo,
  • Mimi Xu,
  • Rongfang Shen,
  • Meifang Wang,
  • Qinyun Wu,
  • Tianlu Zhang,
  • Zhenpeng Jin,
  • Pengpeng Yan,
  • Luying Guo,
  • Jingyi Zhou,
  • Qin Zhou,
  • Huiping Wang,
  • Kui Zhao,
  • Xinhui Su,
  • Rending Wang

摘要

Purpose

Rejection, especially chronic rejection is a key factor influencing the prognosis of kidney transplantation patients. While 18F-fibroblast activation protein inhibitor (FAPI)-04 PET/CT has been widely utilized for diagnosing various diseases, its diagnostic efficacy in kidney transplant rejection remains unexplored.

Methods

In this study, 24 kidney transplant recipients were prospectively enrolled and divided into a control cohort and a rejection cohort (KTR), which were further classified into acute rejection (AR), mixed rejection (MR), and chronic rejection (CR) subgroups. All patients underwent 18F-FAPI-04 PET/CT and 18F-FDG PET/CT scans, along with immunohistochemical FAP staining and Banff pathological scoring. The maximum and average standardized uptake values (SUVs) of the two imaging methods were calculated.

Results

Compared with the control cohort, the KTR cohort showed significantly higher serum creatinine levels, lower estimated glomerular filtration rates, and lower hemoglobin levels. The SUVmax of 18F-FAPI-04 PET/CT in the allograft kidney cortex (AKC) and allograft kidney biopsy site (AKB) in the KTR cohort was significantly greater than that in the control cohort. The SUVmax of 18F-FDG PET/CT between the two cohorts was significantly different only in the AKC. For the KTR cohort, the SUVmax of 18F-FAPI-04 PET/CT in AKC and AKB was considerably greater than that of 18F-FDG PET/CT (5.5 vs. 2.8 and 3.6 vs. 2.5, respectively; both p < 0.01). In the CR cohort, the SUVmax of 18F-FAPI-04 PET/CT in the AKC, AKB, and allograft kidney medulla (AKM) was significantly greater (7.1, 5.3, and 3.2) than that of 18F-FDG PET/CT (2.5, 2.1 and 1.8) (p = 0.009, 0.009 and 0.016, respectively). The SUVmax of 18F-FAPI-04 PET/CT in AKB increased gradually in the AR, MR, and CR cohorts (2.8 vs. 3.6 vs. 5.3, p = 0.02). The above results were consistent with the SUVavg statistics. The number of FAP-positive stromal cells was different between the control and KTR groups and among the AR, MR, and CR subgroups.

Conclusion

18F-FAPI-04 PET/CT outperforms 18F-FDG PET/CT in distinguishing kidney transplant rejection, especially chronic rejection.