The Microbiota and Kidney Transplantation: Influence on the Graft

Abstract

The gut microbial community may be associated with complications after kidney transplantation. The indigenous microbiota has a significant and protective function that influences the transplant recipient response. Genetic or environmental factors may modify the indigenous microbiota and pathobionts appear. In this condition, several disturbances of the kidney graft may be observed. These include acute rejection, infection, diarrhoea, disturbance in the induction of tolerance, and modification of immunosuppressive drug metabolism. Recently, the use of prebiotics, probiotics, and synbiotics has been demonstrated to be effective in normalising these conditions and in restoring the generation of the normal indigenous microbiota. An improved understanding of the function and composition of the indigenous microbiota may help in finding further solutions to stabilise the microbiota after kidney transplantation.

The Impact of Human Microbiotas in Hematopoietic Stem Cell and Organ Transplantation

“…Checkpoint inhibitor therapy is a type of cancer immunotherapy that targets and binds to key immune checkpoint proteins, thereby blocking T-cell inhibitory responses, restoring immune function, and consequently directing the immune system against malignant cells ( 199 – 201 ). The authors reported an association between higher microbial diversity and optimistic treatment outcomes, a finding in agreement with observations made in studies investigating allograft maintenance outcomes in the context of different human microbiotas ( 141 , 143 , 202 – 204 ). The metagenomic implications of different chemotherapeutic as well as dietary interventions in renal cell carcinoma patients is an area of active investigation.…”

“…Over the past several years, there has been a prominent increase in interest surrounding the various human microbiotas and their respective roles in kidney allograft maintenance as well as rejection ( 141 ). Furthermore, in addition to the five types of non-invasive chronic kidney transplant rejection biomarker technologies (transcriptomic, cellular, epigenetic, proteomic, and metabolomic) currently utilized, the human microbiota may also become an insightful biomarker to predict allograft outcomes, therapy responsiveness, and patient-specific susceptibilities/sensitivities to specific drugs such as antimicrobials and immunosuppressants ( 130 , 139 , 142 , 143 ).…”

“…To complicate matters even further, some immunosuppressant drugs such as tacrolimus and sirolimus can function as a macrolide antibiotic ( 132 , 172 ). In fact, there is a significant degree of heterogeneity in the administered pharmaceutical regimens among the different patient cohorts reported in recent clinical studies investigating different human microbiotas in the context of renal transplantation ( 132 , 141 , 143 ). Therefore, it is unsurprising that the effects of immunosuppression on the microbiotas of transplant recipients can be confounded by the effects of antimicrobials as well as the cocktail of other concurrently prescribed drugs.…”

Faecal Microbiota Transplantation and Chronic Kidney Disease

“…FMT is an established therapy for recurrent CDI, with a treatment efficacy above 85% [42]. Moreover, accumulating studies have shown the benefit of FMT for several diseases associated with dysregulated gut microbiota, including autism, cancer, and type 2 diabetes [7,[43][44][45][46]. Although studies using FMT to prevent or treat CKD are still limited, preliminary evidence of the efficacy of FMT indicates that the application of FMT may offer a promising alternative for the treatment of CKD.…”