Application of Syndromic Panels for respiratory Tract Infections in Lung Transplantation: A Critical Review on Current Evidence and Future Perspectives

Background: Infections are a common complication among lung transplant recipients (LuTR), particularly in the first year post-transplant, with respiratory tract infections (RTI) being predominant. Syndromic molecular panels have been suggested to reduce morbidity and mortality by providing a diagnosis quickly. However, integrating these panels into clinical practice remains debated. Methods: An electronic search was conducted in PubMed, Scopus, and Embase to identify studies on applying syndromic panels for RTI diagnosis in LuTR. Three reviewers independently screened-extracted data from relevant studies, focusing on concordance between syndromic panels and standard microbiologic tests and reporting isolates not detected by syndromic panels. Results: Four studies met the inclusion criteria, including 308 patients. The BioFire FilmArray Pneumonia Panel was the syndromic panel most frequently employed. In three studies, the syndromic panel was employed in LuTR with suspected RTI or during routine surveillance bronchoalveolar lavage; only in one case was the syndromic panel employed during the transplant procedure on samples from the donor. Agreement between syndromic panels and standard tests ranged from 0.56 to 0.98, with result turnaround times between 2.3 and 21.2 h. Sensitivity ranged from 58% to 94%, and specificity from 78% to 100%. Pathogens outside syndromic panels targets but identified by standard tests included Candida spp., unspecified gram-negative rods, and Aspergillus spp. Conclusion: Syndromic panels offer a faster alternative to standard microbiologic tests. However, they miss numerous possible pathogens, highlighting the necessity for concurrent standard testing. Further research is needed to establish the most efficient integration of syndromic panels in LuTx infection diagnostic. (Figure presented.).