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Review
. 2021 Dec 1;26(6):582-586.
doi: 10.1097/MOT.0000000000000921.

New insights into the microbiome in kidney transplantation

Joshua S Kim  1 , Christina Sze  2 , Tarek Barbar  3 , John R Lee  3   4
Affiliations
Review

New insights into the microbiome in kidney transplantation

Joshua S Kim et al. Curr Opin Organ Transplant. .

Abstract

Purpose of review: Research in the past decade has revealed important implications for the microbiome in human health. Studies have defined a distinct gut microbiota in kidney transplant recipients and have recently linked the microbiota to infectious complications, similar to the allogeneic stem cell transplant population.

Recent findings: In this review, we focus on the metabolism of immunosuppressive medications by the gut microbiota and on the urinary microbiome in the setting of infectious and immunological complications. We highlight seminal studies showing the role of specific gut microbiota in the direct metabolism of tacrolimus into a lesser effective immunosuppressant as well as the role of the gut microbiota in the metabolism of mycophenolic acid (MPA) glucuronide. We describe distinct urinary microbiota patterns in kidney transplant recipients with interstitial fibrosis tubular atrophy, chronic allograft nephropathy, tolerance, and bacterial and viral complications.

Summary: The microbiota has important implications for immunosuppressive medications and immunological outcomes in kidney transplant recipients. Further research is needed to better delineate the impact of the metabolism of tacrolimus and MPA by gut bacteria and the role of the urine microbiota in the development of immunological and infectious complications.

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Conflict of interest statement

Conflicts of Interest

J.R.L. hold patent US-2020-0048713-A1 titled “Methods of Detecting Cell-Free DNA in Biological Samples” and receives research support under an investigator-initiated research grant from BioFire Diagnostics, LLC.

References

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    2. * The authors demonstrate that the gut abundance of uropathogens are associated with development of urinary tract infection in kidney transplant recipients.

    1. Lee JR, Huang J, Magruder M, Zhang LT, Gong C, Sholi AN, et al. Butyrate-producing gut bacteria and viral infections in kidney transplant recipients: A pilot study. Transplant Infectious Disease. 2019;21(6):e13180. - PMC - PubMed

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