{
  "abstract": "Background: Post-transplant infections remain a leading cause of morbidity and mortality after liver transplantation (LT). Conventional microbiological culture has well-recognized limitations in sensitivity and pathogen spectrum coverage. Metagenomic next-generation sequencing (mNGS) has emerged as a promising diagnostic platform. However, its systematic evaluation across matched donor–recipient pairs, including characterization of possible donor-to-recipient pathogen transmission and its impact on antimicrobial stewardship, remains limited.\n\nMethods: We retrospectively enrolled 45 consecutive LT donor–recipient pairs. Multiple sample types were collected from donors (n = 124) and recipients (n = 97) and subjected to both mNGS and conventional culture. Recipients were stratified into infection (n = 29) and non-infection (n = 16) groups. Pathogen detection rates, diagnostic performance metrics, donor-to-recipient transmission events, and mNGS-informed antimicrobial modifications were systematically analyzed.\n\nResults: Post-transplant infection occurred in 64.4% of recipients, predominantly involving the pulmonary compartment (89.7%). mNGS achieved significantly higher overall positivity rates than culture in both donors (95.6% vs. 80.0%) and recipients (64.4% vs. 22.2%), with superior detection of fungi and exclusive identification of all viral pathogens. The pathogen-level concordance between methods was predominantly partial (75%–78%). At the patient level, mNGS demonstrated a sensitivity of 69.0% versus 31.0% for culture, while culture maintained higher specificity (93.8% vs. 43.8%). A diverse pathogen landscape was identified, including Pneumocystis jirovecii, rare molds, cytomegalovirus (CMV), and Epstein–Barr virus (EBV)—all exclusively detected by mNGS. A total of 11 possible donor-to-recipient transmission events involving six pathogens were identified across 11 pairs, and 54.5% of affected recipients developed clinical infections, with Klebsiella pneumoniae accounting for the majority of transmission events. mNGS results informed antimicrobial treatment modifications in 69.0% of infected recipients. In the univariate analysis, liver cancer showed an exploratory association with lower post-transplant infection risk (OR = 0.10, 95%CI = 0.02–0.46, p = 0.003).\n\nConclusions: This retrospective matched-pair study suggests that mNGS substantially expands pathogen detection beyond conventional culture, enabling the identification of clinically relevant possible donor-derived pathogen transmission and informing antimicrobial treatment modifications in the majority of infected recipients. These findings support mNGS as an adjunctive peri-transplant diagnostic tool pending prospective multicenter validation.",
  "abstract_shown": true,
  "affiliations": [
    "Organ Transplantation Center, The Affiliated Hospital of Qingdao University , , ,",
    "WillingMed Technology (Beijing) Co., Ltd , ,",
    "Department of Orthopaedics, The Affiliated Hospital of Qingdao University , , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Shuai Feng"
    },
    {
      "affs": [
        0
      ],
      "name": "Jinquan Liu"
    },
    {
      "affs": [
        1
      ],
      "name": "Xiaojing Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Lianghao Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Shengbao Zhao"
    },
    {
      "affs": [
        2
      ],
      "name": "Nannan Jiang"
    },
    {
      "affs": [
        0
      ],
      "name": "Jinzhen Cai"
    },
    {
      "affs": [
        1
      ],
      "name": "Yafeng Zheng"
    },
    {
      "affs": [
        1
      ],
      "name": "Wei Gai"
    },
    {
      "affs": [
        0
      ],
      "name": "Chuanshen Xu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/erddzfke6wkjs.bib",
  "cited_by": 0,
  "doi": "10.3389/fcimb.2026.1919428",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13724449/?tool=EBI",
  "id": "erddzfke6wkjs",
  "issns": [
    "2235-2988"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13724449",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "1308|Bacterial Identification and Susceptibility Testing"
    ]
  ],
  "openalex": "W7222951916",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13724449/pdf/?tool=EBI",
  "pmcid": "PMC13724449",
  "pmid": "42973731",
  "published": "2026-10-19",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/erddzfke6wkjs.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:51Z",
      "native_id": "PMC:PMC13724449",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13724449"
    },
    {
      "first_seen": "2026-11-04T12:23:01Z",
      "native_id": "PMC13724449",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fcimb.2026.1919428"
    },
    {
      "first_seen": "2026-11-04T15:20:48Z",
      "native_id": "MED:42973731",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42973731"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:1308|Bacterial Identification and Susceptibility Testing",
      "subfield": "general"
    }
  ],
  "title": "Metagenomic next-generation sequencing of matched donor–recipient pairs reveals pathogen transmission dynamics and informs antimicrobial therapy in liver transplantation: a retrospective cohort study",
  "title_text": "Metagenomic next-generation sequencing of matched donor–recipient pairs reveals pathogen transmission dynamics and informs antimicrobial therapy in liver transplantation: a retrospective cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:21:12Z",
  "url": "https://research.draconitic.com/paper/erddzfke6wkjs",
  "venue": "Frontiers in cellular and infection microbiology",
  "versions": []
}