Abstract:

Objective To investigate the diagnostic value of metagenomic next-generation sequencing （mNGS） in determining pathogens in bronchoalveolar lavage fluid （BALF） of renal transplant patients for pulmonary infections. Methods Totally，50 patients with pulmonary infections after renal transplantation from Zhengzhou People's Hospital from July 2020 to October 2023 were enrolled. The clinical data were collected.The BALF samples were collected，and mNGS and conventional methods were used to determine pathogens simultaneously. The consistency of the determination results of the 2 methods was analyzed. The diagnostic value of mNGS for bacterial，fungal，viral and mixed infections was evaluated. Results A total of 59 pathogens were determined in the BALF samples of 50 patients. Among them，mNGS determined 56 pathogens，while the conventional method determined 22 pathogens. The determination rate of pathogens by mNGS（98.0%）was higher than that by the conventional method（60.0%）（P<0.001）. The consistency rate of the determination results of the 2 methods was 62.0%，and the consistency was poor（Kappa=0.059）. The positive determination rates of bacteria，fungi and viruses by mNGS were 74.0%，62.0% and 86.0%，respectively，which were higher than those by the conventional method（the positive determination rates were 32.0%，16.0% and 36.0%，respectively）（P<0.05）. The determination rate of mixed infections by mNGS（86.0%）was also higher than that by the conventional method（24.0%）（P<0.001）. Moreover，the combined determination rate of mNGS and conventional method for mixed infections was 91.84%. Conclusions The mNGS can increase the determination rate of pathogens in BALF samples of renal transplant patients with pulmonary infections. The mNGS combined with conventional methods has advantages in the diagnosis of mixed infections and can provide a reference for early and precise identification of pathogens.

Key words: Metagenomic next-generation sequencing, Renal transplantation, Pulmonary infection