Abstract

Relevance. Worldwide, people recognise kidney transplantation as the standard treatment for end-stage kidney failure. However, impaired graft function frequently complicates the early postoperative period. The most common causes of early dysfunction are acute tubular necrosis and acute rejection. These conditions are difficult to distinguish from one another because they have similar clinical manifestations and routine monitoring methods are limited.

Aim. To describe the evidence relating to the diagnostic accuracy and capabilities of dynamic renal scintigraphy with 99mTc-DTPA in distinguishing acute tubular necrosis from renal allograft rejection.

Materials and methods. To identify relevant publications, searches were conducted in the international databases PubMed, Scopus, Web of Science and Google Scholar, with a focus on the period from January 2020 to January 2026. The analysis included studies that looked at how 99mTc-DTPA scintigraphy is used in adult kidney transplant patients. This was confirmed by either a biopsy or by checking the patient’s progress over time. This review is limited by the fact that no formal risk-of-bias assessment was performed. A total of 22 sources were included in the final analysis. The comprehensiveness of the global evidence included in this review may have been affected by the fact that it was limited to English- and Ukrainian-language publications.

Results. Analysis of the literature indicates that the key criterion for scintigraphic differentiation is assessing the relationship between graft perfusion and function. Acute tubular necrosis is characterised by a dissociation phenomenon, with preserved perfusion despite reduced excretory function. In contrast, acute rejection is accompanied by a parallel deterioration in haemodynamics and function caused by increased vascular resistance. Using semi-automated quantitative parameters, particularly the Hilson and Kirchner indices, has been shown to strongly correlate with biopsy findings. According to the available literature, this method has a sensitivity of 98% for diagnosing acute tubular necrosis and 87% for detecting acute rejection. Even in cases of reduced graft function, 99mTc-DTPA is the optimal radiopharmaceutical for the routine assessment of perfusion indices thanks to its cost-effectiveness.

Conclusions. Dynamic renal scintigraphy with 99mTc-DTPA is an effective non-invasive diagnostic method. It enables haemodynamic abnormalities in the allograft to be detected at the preclinical stage. Quantitative perfusion indices provide an objective basis for the diagnostic process, allow reliable differentiation between ischaemic and immunological complications, and minimise the need for invasive procedures. This facilitates the timely selection of an appropriate treatment strategy.