{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T10:03:00Z","timestamp":1790848980966,"version":"4.1.0"},"reference-count":36,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Acute tubular necrosis (ATN) and acute rejection are the principal parenchymal causes of early kidney allograft dysfunction, and biopsy is the reference standard for distinguishing them. We assessed 99mTc-MAG3 scintigraphy against biopsy. Methods: Single-center retrospective study of transplants (2016 to 2025) scanned within 90 days for suspected graft dysfunction: 42 transplants in 41 recipients, 10% of 420 screened. Accuracy was calculated only in the 25 with a paired biopsy, with exact 95% confidence intervals (CIs). Because biopsy was performed on clinical indication and not in all patients, verification bias was quantified by Begg\u2013Greenes correction and extreme-case bounds. Results: Scintigraphy was performed a median of 8 days after transplantation; 69% had delayed graft function. Scans were read as ATN in 31 (74%), normal in seven (17%), rejection in three (7%) and obstruction in one; biopsy showed ATN in 15, rejection in six and normal histology in four. For ATN, sensitivity was 14\/15 (93.3%; CI 68.1 to 99.8), specificity 7\/10 (70.0%; 34.8 to 93.3) and positive predictive value 14\/17 (82.4%; 56.6 to 96.2). For rejection, sensitivity was 3\/6 (50.0%; 11.8 to 88.2) and specificity 19\/19 (100%; 82.4 to 100), the predictive value of three positive scans being uninformative (CI 29.2 to 100). Correcting for verification placed ATN specificity between 29.2% and 76.9% and rejection sensitivity between 13.0% and 50.0%. Conclusions: Scintigraphy rarely missed biopsy-proven ATN but was not specific and identified only half of the rejection episodes. These estimates rest on small numbers in a clinically selected population; biopsy remains necessary whenever rejection is suspected, and they do not apply to routine or protocol scintigraphy.<\/jats:p>","DOI":"10.3390\/diagnostics16193193","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:38:16Z","timestamp":1790847496000},"page":"3193","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Performance of 99mTc-MAG3 Renal Scintigraphy for Acute Tubular Necrosis and Acute Rejection in Kidney Transplant Recipients with Suspected Graft Dysfunction During the First 90 Days: A Single-Center, Biopsy-Referenced Retrospective Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0172-3844","authenticated-orcid":false,"given":"Ashraf","family":"Imam","sequence":"first","affiliation":[{"name":"Organ Transplantation Unit, Department of Surgery, Hadassah-Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Suha","family":"Shabaneh","sequence":"additional","affiliation":[{"name":"Organ Transplantation Unit, Department of Surgery, Hadassah-Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"}]},{"given":"Riham","family":"Imam","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hadassah-Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Michael","family":"Rivin","sequence":"additional","affiliation":[{"name":"Organ Transplantation Unit, Department of Surgery, Hadassah-Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3556-1054","authenticated-orcid":false,"given":"Ahmad","family":"Salhab","sequence":"additional","affiliation":[{"name":"Organ Transplantation Unit, Department of Surgery, Hadassah-Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4541-522X","authenticated-orcid":false,"given":"Itamar","family":"Tamir","sequence":"additional","affiliation":[{"name":"Department of Radiology, Hadassah-Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"given":"Keren","family":"Tzukert","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hadassah-Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Roy","family":"Abel","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hadassah-Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"}]},{"given":"Simona","family":"Ben-Haim","sequence":"additional","affiliation":[{"name":"Department of Medical Biophysics and Nuclear Medicine, Hadassah-Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6706-3837","authenticated-orcid":false,"given":"Harbi","family":"Khalayleh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kaplan-Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Oded","family":"Cohen-Arazi","sequence":"additional","affiliation":[{"name":"Organ Transplantation Unit, Department of Surgery, Hadassah-Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4878-8189","authenticated-orcid":false,"given":"Abed","family":"Khalaileh","sequence":"additional","affiliation":[{"name":"Organ Transplantation Unit, Department of Surgery, Hadassah-Hebrew University of Jerusalem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"471","DOI":"10.2215\/CJN.05021107","article-title":"Kidney transplantation as primary therapy for end-stage renal disease: A National Kidney Foundation\/Kidney Disease Outcomes Quality Initiative (NKF\/KDOQI) conference","volume":"3","author":"Abecassis","year":"2008","journal-title":"Clin. 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Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/19\/3193\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:50:30Z","timestamp":1790848230000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/19\/3193"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":36,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["diagnostics16193193"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16193193","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]}}}