FDG-PET/CT in Heart Transplant

Abstract

Heart transplantation remains the best treatment option for patients with end-stage heart failure to improve quality of life and survival despite significant improvements in both medical therapies and mechanical circulatory support devices. Nevertheless, given the shortage of donor hearts and increased waiting time, more patients need mechanical circulatory support as a bridge to transplant or even as destination therapy with an inherent risk of infectious complications. Furthermore, heart transplant recipients are at risk for developing several mild to potentially life-threatening complications, thereby impairing their outcome. These complications vary according to the time after transplant surgery and can be divided into graft-related (early graft failure, allograft rejection, and cardiac allograft vasculopathy) and non–graft-related disorders such as infections and malignancies. Positron emission tomography combined with computed tomography using 2-deoxy-2-[18F]fluoro-D-glucose (FDG-PET/CT) is an established tool in oncology and has become the reference standard to noninvasively assess infectious and inflammatory processes with high accuracy. This chapter provides a brief overview on the current state of heart transplantation and complications during the posttransplant period. Secondly, a concise update is given on the diagnostic value of FDG-PET/CT in ventricular assist device infections in the pretransplant setting. Then, graft-related complications are discussed focusing on the potential role of FDG-PET/CT to detect allograft rejection. The last part summarizes the current evidence on the use of FDG-PET/CT in the workup of infectious complications and lymphoproliferative disorders after heart transplantation.