Abstract
BACKGROUND: Prompt identification and management of donor-derived infections post-kidney transplantation are critical. This study aims to assess the effectiveness of metagenomic next-generation sequencing (mNGS) in detecting pathogens within donor organ preservation fluids and recipient wound drainage fluids, with a comparison made against conventional culture methods. METHODS: This study involved 141 kidney transplant patients (May 1st, 2020 to Jan 31st, 2024). Donor organ preservation fluids and recipient wound drainage fluids were collected and analyzed by mNGS and conventional culture. Pathogen detection differences between mNGS and culture were evaluated. The antibiotic adjustment and infectious complications of the recipients were recorded. RESULTS: For organ preservation fluids, the positive rate of convention culture were lower than that of mNGS (24.8% (35/141) vs 47.5% (67/141), p<0.05). For recipient wound drainage fluids, the positivity rate of convention culture were lower than that of mNGS (2.1% (3/141) vs 27.0% (38/141), p<0.05). Compared to traditional culture-based methods, mNGS demonstrated a significantly higher positive detection rate for the combination of ESKAPE pathogens and/or fungi (28.4% (40/141) vs 16.3% (23/141) p< 0.05). Of the pathogens detected through convention culture, mNGS was capable of detecting 79.2% (19/24) of combinations comprising Enterobacteriaceae and non-fermenting bacteria, yet it detected only 22.2% (2/9) of Gram-positive bacteria, and 55.6% (5/9) of fungi. Certain clinically atypical pathogens, mainly Mycobacterium, Clostridium tetanus, and parasites, can solely be detected via mNGS. The rehospitalization rate due to infections was 13.5% (19/141), while the donor-derived infection rate amounted to 2.8% (4/141). Guided by mNGS and bacterial culture results, adjustments were made to antibiotic administration, with no severe vascular complications arising. CONCLUSIONS: By employing mNGS to analyze drainage fluids and organ preservation fluids, highly pathogenic and atypical pathogenic microorganisms can be rapidly identified with high throughput. While limitations exist in detecting fungi and Gram-positive bacteria, mNGS are need to be jointly applied with conventional culture under current conditions.