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Bronchoalveolar Lavage Metagenomic Sequencing in the Early Post-Lung Transplantation Period: A Pilot Comparison with Microbiologic Culture
By Kitsios GD, Sy MA, Friday K and 17 others.
Abstract
Background
Conventional bronchoalveolar lavage (BAL) culture has limited sensitivity in lung transplant recipients due to universal antimicrobial prophylaxis and inability to detect non-culturable organisms. Metagenomic sequencing of BAL offers culture-independent pathogen identification, but concordance with conventional culture and clinical utility in the immediate post-transplant period have not been evaluated.
Methods
We prospectively enrolled 19 adult lung transplant recipients undergoing serial bronchoscopies during the immediate post-transplant period. BAL samples (n=33) were tested in parallel with conventional culture, microbial cell-free DNA (mcfDNA) sequencing (Karius Focus™ | BAL; with quantitation determined by research analysis), and Oxford Nanopore sequencing using a unified three-tier organism classification framework. BAL host-response biomarkers were profiled concurrently.
