The Gut Microbiome and Symptom Burden After Kidney Transplantation: An Overview and Research Opportunities

Author:

Lockwood Mark B.1ORCID,Sung Choa2ORCID,Alvernaz Suzanne A.3,Lee John R.4,Chin Jennifer L.5,Nayebpour Mehdi6,Bernabé Beatriz Peñalver3,Tussing-Humphreys Lisa M.7,Li Hongjin1,Spaggiari Mario8,Martinino Alessandro8,Park Chang G.9,Chlipala George E.10ORCID,Doorenbos Ardith Z.11,Green Stefan J.12

Affiliation:

1. Department of Biobehavioral Nursing Science, University of Illinois Chicago College of Nursing, Chicago, IL, USA

2. Post-Doctoral Fellow, Department of Biobehavioral Nursing Science, University of Illinois Chicago College of Nursing, Chicago, IL, USA

3. Graduate Student, Department of Biomedical Engineering, University of Illinois ChicagoColleges of Engineering and Medicine, Chicago, IL, USA

4. Division of Nephrology and Hypertension, Department of Medicine, Weill Cornell Medicine, New York, NY, USA

5. Medical Student, Touro College of Osteopathic Medicine, Middletown, NY, USA

6. Virginia BioAnalytics LLC, Washington, District of Columbia, USA

7. Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA

8. Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA

9. Department of Population Health Nursing Science, Office of Research Facilitation, University of Illinois Chicago, Chicago, IL, USA

10. Research Core Facility, Research Resources Center, University of Illinois Chicago, Chicago, IL, USA

11. Department of Biobehavioral Nursing Science, University of Illinois ChicagoCollege of Nursing, Chicago, IL, USA

12. Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA

Abstract

Many kidney transplant recipients continue to experience high symptom burden despite restoration of kidney function. High symptom burden is a significant driver of quality of life. In the post-transplant setting, high symptom burden has been linked to negative outcomes including medication non-adherence, allograft rejection, graft loss, and even mortality. Symbiotic bacteria (microbiota) in the human gastrointestinal tract critically interact with the immune, endocrine, and neurological systems to maintain homeostasis of the host. The gut microbiome has been proposed as an underlying mechanism mediating symptoms in several chronic medical conditions including irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, and psychoneurological disorders via the gut-brain-microbiota axis, a bidirectional signaling pathway between the enteric and central nervous system. Post-transplant exposure to antibiotics, antivirals, and immunosuppressant medications results in significant alterations in gut microbiota community composition and function, which in turn alter these commensal microorganisms’ protective effects. This overview will discuss the current state of the science on the effects of the gut microbiome on symptom burden in kidney transplantation and future directions to guide this field of study.

Funder

National Institute of Nursing Research

National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health

NCATS

BioFire Diagnostics, LLC

Astellas

Publisher

SAGE Publications

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