Metagenomic Next-Generation Sequencing-Assisted Risk Prediction and Stratification of Infections After Kidney Transplantation: A Case Study of COVID-19.

Background: During the COVID-19 pandemic, COVID-19 infection has severely damaged the transplanted kidney function and health of kidney transplant patients. This study aims to investigate the clinical characteristics, risk factors and predictors of severe COVID-19 in patients after kidney transplantation.

Material and methods: The clinical data of patients with COVID-19 after kidney transplantation were collected from December 2022 to January 2023 at the First Affiliated Hospital of Soochow University. Logistic regression analysis was performed to identify risk factors for severe disease and to construct a nomogram model. Concurrently, metagenomic next-generation sequencing (mNGS) was employed to detect the sputum microbiome.

Results: A total of 58 patients were enrolled and were categorized into the common group (n=35) and the severe group (n=23) based on infection severity. The common group comprised 23 males with a mean age of 45.60 ± 9.11 years, while the severe group included 16 males with a mean age of 48.22 ± 9.95 years. Multivariate logistic analysis revealed that days of fever before hospitalization, C-reactive protein (CRP) and interleukin-10 (IL-10) on admission were significantly independent risk factors for severity, with an area under the ROC curve at 0.906. Comparison of the sputum microbiome revealed that there were no significant differences in α and β diversity between the two groups. Streptococcus parasanguinis was significantly more abundant in the specimens from the severe group, while Gemella sanguinis and Gemella haemolysans were significantly more abundant in the common group.

Conclusion: The severity of COVID-19 in kidney transplant patients is associated with days of fever before hospitalization, and the levels of CRP and IL-10 at admission, which also alter the abundance of certain species in the sputum microbiome. Therefore, it is necessary to actively monitor the clinical indicators of kidney transplant patients admitted with COVID-19 to reduce the risk of progression to severe disease.