# Metagenomic next-generation sequencing enhances diagnosis of fungal infections in kidney transplant recipients: a retrospective study

## TL;DR

Metagenomic sequencing improves detection of fungal infections in kidney transplant patients, leading to better treatment decisions and outcomes.

## Contribution

Demonstrates mNGS's superior performance over conventional methods in diagnosing fungal infections in transplant recipients.

## Key findings

- mNGS detected 18 fungal species compared to 10 by conventional methods.
- mNGS identified donor-derived fungal infections in 6.7% of patients.
- mNGS led to treatment adjustments in 24.4% of cases.

## Abstract

Although fungal infections are relatively rare, they have low detection rates and high mortality rates. The value of metagenomic next-generation sequencing (mNGS) in kidney transplant patients with fungal infections remains insufficiently explored, especially regarding diagnosis and antimicrobial stewardship.

From September 2021 to August 2023, 234 kidney transplant patients were enrolled, with detailed data collected on 66 patients suspected of fungal infections. The pathogen detection performance of mNGS and conventional microbiological tests (CMTs) was compared. The impacts of mNGS and CMTs on treatment adjustment were also assessed. Finally, the value of mNGS in detecting donor-derived infections was investigated.

Among 66 patients, 21 fungal species were identified: 18 species detected by mNGS and 10 by CMTs. The overall positive rate of mNGS was significantly higher than culture (90.67% vs. 26.67%), especially for multiple fungal infections (9vs0). mNGS identified more Candida (26vs12), Pneumocystis jirovecii (14vs0), Aspergillus (10vs4), Mucor (6vs2) organisms compared with CMTs. Donor-derived fungi were identified in 11 (6.7%) patients, including 10 cases of Candida spp. and 1 case of Mucor spp. Anti-infection therapies were adjusted in 28 (24.4%) cases based on mNGS.

The mNGS technique showed distinct advantages in detecting fungal infections in kidney transplant patients, facilitating informed anti-infection strategies and enhanced graft protection. Moreover, it provides effective identification of fungal infections originating from donor sources.