Performance of the BioFire FilmArray Pneumonia Panel Plus Compared to Standard Microbiology in Lung Transplant Donor and Recipient Samples: A Prospective Cohort Study

Background: Lung transplantation (LuTx) is hampered by infectious risks. Perioperative antibiotic prophylaxis (PAP) is widely used; however, real-time adjustment is hindered by the timing of standard microbiology. Syndromic molecular panels offer rapid results, yet their integration into PAP strategies remains unclear. Methods: We conducted a prospective cohort study comparing the BioFire FilmArray Pneumonia Panel Plus (PNplus) with standard of care (SOC) on bronchoalveolar lavage (BAL) samples obtained from donors at procurement and from recipients 72 h after LuTx. Concordance between PNplus and SOC was assessed for bacterial species and antimicrobial resistance genes. Results: Fifty-three donor-recipient pairs were analyzed. In donor BAL, PNplus identified at least one pathogen in 67.9% (36/53) of cases versus 63.5% (33/53) by SOC, with a markedly shorter time to result (221 min vs. 5.3 days). Concordance between PNplus and SOC for bacterial species was substantial (Cohen's κ = 0.654), particularly for Staphylococcus aureus (Cohen's κ = 0.689), Streptococcus pneumoniae (Cohen's κ = 0.658), and Pseudomonas aeruginosa (Cohen's κ = 0.731). In recipient BAL, PNplus detected pathogens in 61.5% (32/53) compared to 47.2% (25/53) with SOC, but overall concordance was only moderate (κ = 0.365). Resistance gene concordance was minimal, with PNplus often identifying additional determinants not confirmed by SOC. Viruses were detected exclusively by PNplus, while fungi were identified only by SOC. Conclusion: PNplus provides rapid, clinically relevant pathogen detection in LuTx, showing substantial agreement with SOC in donor samples and offering potential to support PAP adjustment. In early post-transplant recipient BAL, interpretation requires caution, and SOC remains indispensable, particularly for detecting fungi and confirming phenotypic resistance. (Figure presented.).