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Review
. 2020 Dec 23:10:558644.
doi: 10.3389/fcimb.2020.558644. eCollection 2020.

Does the Microbiome Affect the Outcome of Renal Transplantation?

Paul M Campbell  1 , Gavin J Humphreys  1 , Angela M Summers  2 , Joanne E Konkel  3 , Christopher G Knight  4 , Titus Augustine  2 , Andrew J McBain  1
Affiliations
Review

Does the Microbiome Affect the Outcome of Renal Transplantation?

Paul M Campbell et al. Front Cell Infect Microbiol. .

Abstract

The role of the human microbiome in health and disease is becoming increasingly apparent. Emerging evidence suggests that the microbiome is affected by solid organ transplantation. Kidney transplantation is the gold standard treatment for End-Stage Renal Disease (ESRD), the advanced stage of Chronic Kidney Disease (CKD). The question of how ESRD and transplantation affect the microbiome and vice versa includes how the microbiome is affected by increased concentrations of toxins such as urea and creatinine (which are elevated in ESRD), whether restoration of renal function following transplantation alters the composition of the microbiome, and the impact of lifelong administration of immunosuppressive drugs on the microbiome. Changes in microbiome composition and activity have been reported in ESRD and in therapeutic immunosuppression, but the effect on the outcome of transplantation is not well-understood. Here, we consider the current evidence that changes in kidney function and immunosuppression following transplantation influence the oral, gut, and urinary microbiomes in kidney transplant patients. The potential for changes in these microbiomes to lead to disease, systemic inflammation, or rejection of the organ itself is discussed, along with the possibility that restoration of kidney function might re-establish orthobiosis.

Keywords: chronic kidney disease; end stage renal disease; gut microbiome; kidney transplant; oral microbiome; renal allograft; surgery; urinary microbiome.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Summary of differences found at key body sites in studies of Chronic Kidney Disease (CKD) patients and kidney transplant recipients post-operation discussed in this review. For CKD patients, health changes associated with microbiome alteration include: (Oral) increased urea and pH (Lasisi et al., 2016), plaque, enamel defects, gingival enlargement and decreased caries (Al Nowaiser et al., 2003), (Kidney) declining function and build-up of toxins (Pandya et al., 2016), and (Gut) gut dysfunction and disruption of epithelial tight junction (Vaziri et al., 2013b). Reported microbial change includes significant changes in oral and gut communities compared with healthy controls (Hu et al., 2018; Hobby et al., 2019). For kidney transplant recipients, post-transplant health changes associated with microbiome alteration include: (Oral) increased mucosal lesions, gingival hyperplasia, risk of extra-oral colonization, and squamous cell carcinoma (Spolidorio et al., 2006), (Kidney) variations in time taken for graft to function (Yarlagadda et al., 2009; Willicombe et al., 2017), (Gut) increased diarrheal episodes (Lee et al., 2014), and (Urinary Tract) increases in urinary tract infections (Giessing, 2012). Microbial changes include: (Oral) increased abundance of Candida species (Spolidorio et al., 2006), total viable microorganism counts (Saraiva et al., 2006), and relative abundance of opportunistic pathogens (Diaz et al., 2013), (Gut) increased relative abundance of Proteobacteria (Lee et al., 2014), changes in microbial metabolism between (i) immunosuppressive regimens (Zaza et al., 2017), as well as microbial community structure in (ii) rejection and non-rejection patients (Lee et al., 2014) and (iii) diarrheal and non-diarrheal patients (Lee et al., 2019). (Urinary Tract) Structurally different microbiomes are also seen in transplant recipients (Fricke et al., 2014), as well as chronic allograft dysfunction (Wu et al., 2018) and interstistal fibrosis and tubular atrophy patients (Modena et al., 2017).
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References

    1. Ahn S. Y., Ingulli E. (2008). Acute poststreptococcal glomerulonephritis: an update. Curr. Opin. Pediatr. 20, 157–162. 10.1097/MOP.0b013e3282f45bcf - DOI - PubMed
    1. Al Khodor S., Shatat I. F. (2017). Gut microbiome and kidney disease: a bidirectional relationship. Pediatr. Nephrol. 32, 921–931. 10.1007/s00467-016-3392-7 - DOI - PMC - PubMed
    1. Al Nowaiser A., Roberts G., Trompeter R., Wilson M., Lucas V. (2003). Oral health in children with chronic renal failure. Pediatr. Nephrol. 18, 39–45. 10.1007/s00467-002-0999-7 - DOI - PubMed
    1. Andrade M. R. T. C., Antunes L. A. A., Soares R. M. D. A., Leão A. T. T., Maia L. C., Primo L. G. (2013). Lower dental caries prevalence associated to chronic kidney disease: a systematic review. Pediatr. Nephrol. 29, 771–778. 10.1007/s00467-013-2437-4 - DOI - PubMed
    1. Andrade-Oliveira V., Amano M. T., Correa-Costa M., Castoldi A., Felizardo R. J., De Almeida D. C., et al. (2015). Gut Bacteria Products Prevent AKI Induced by Ischemia-Reperfusion. J. Am. Soc. Nephrol. 26, 1877–1888. 10.1681/ASN.2014030288 - DOI - PMC - PubMed

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