Positive Metagenomic Next-Generation Sequencing of Renal Lavage Fluid Associates with Delayed Graft Function in Kidney Transplants from Donors After Circulatory Death: A Retrospective Study

Delayed graft function (DGF) is a major complication in kidney transplants from donation after circulatory death (DCD). This study assessed the association between metagenomic next-generation sequencing (mNGS) results and the occurrence of DGF during the perioperative period in DCD kidney transplant recipients. We analyzed 191 DCD kidney transplant recipients in this single-center retrospective cohort study. All recipients underwent routine mNGS testing of renal lavage fluid between July 2021 and July 2024. Demographic, clinical, and microbial data were collected. Associations between mNGS results and DGF were evaluated using logistic regression models adjusted for covariates. The study revealed a strong association between mNGS positivity and DGF development. mNGS-positive recipients (n=97/191) showed significantly higher DGF incidence than mNGS-negative cases (30.9% vs 6.4%, p<0.001), highlighting the potential clinical utility of mNGS in predicting DGF. Multivariate analysis confirmed this association after adjusting for confounders (aOR=7.90, 95% CI 1.63-38.24). Bacterial pathogens constituted the majority of detected microorganisms (62.7%), with prevalent isolates including Enterococcus (37 cases) and Staphylococcus (29 cases) that harbored clinically relevant resistance genes. Our findings demonstrate a significant association between mNGS positivity in renal lavage fluid and DGF development in DCD kidney recipients (aOR 7.90, 95% CI 1.63-38.24), These findings support further investigation into mNGS as a tool for early risk stratification and targeted antimicrobial therapy in DCD kidney recipients.