2
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Zhang LT, Westblade LF, Iqbal F, Taylor MR, Chung A, Satlin MJ, Magruder M, Edusei E, Albakry S, Botticelli B, Robertson A, Alston T, Dadhania DM, Lubetzky M, Hirota SA, Greenway SC, Lee JR. Gut microbiota profiles and fecal beta-glucuronidase activity in kidney transplant recipients with and without post-transplant diarrhea. Clin Transplant 2021; 35:e14260. [PMID: 33605497 DOI: 10.1111/ctr.14260] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/01/2021] [Accepted: 02/13/2021] [Indexed: 12/18/2022]
Abstract
Post-transplant diarrhea is a common complication after solid organ transplantation and is frequently attributed to the widely prescribed immunosuppressant mycophenolate mofetil (MMF). Given recent work identifying the relationship between MMF toxicity and gut bacterial β-glucuronidase activity, we evaluated the relationship between gut microbiota composition, fecal β-glucuronidase activity, and post-transplant diarrhea. We recruited 97 kidney transplant recipients and profiled the gut microbiota in 273 fecal specimens using 16S rRNA gene sequencing. We further characterized fecal β-glucuronidase activity in a subset of this cohort. Kidney transplant recipients with post-transplant diarrhea had decreased gut microbial diversity and decreased relative gut abundances of 12 genera when compared to those without post-transplant diarrhea (adjusted p value < .15, Wilcoxon rank sum test). Among the kidney transplant recipients with post-transplant diarrhea, those with higher fecal β-glucuronidase activity had a more prolonged course of diarrhea (≥7 days) compared to patients with lower fecal β-glucuronidase activity (91% vs 40%, p = .02, Fisher's exact test). Our data reveal post-transplant diarrhea as a complex phenomenon with decreased gut microbial diversity and commensal gut organisms. This study further links commensal bacterial metabolism with an important clinical outcome measure, suggesting fecal β-glucuronidase activity could be a novel biomarker for gastrointestinal-related MMF toxicity.
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Affiliation(s)
- Lisa T Zhang
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA
| | - Lars F Westblade
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.,Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Fatima Iqbal
- Departments of Pediatrics and Biochemistry and Molecular Biology, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael R Taylor
- Departments of Pediatrics and Biochemistry and Molecular Biology, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alice Chung
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA
| | - Michael J Satlin
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Matthew Magruder
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA
| | - Emmanuel Edusei
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA
| | - Shady Albakry
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA
| | - Brittany Botticelli
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA
| | - Amy Robertson
- New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA
| | - Tricia Alston
- New York Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA
| | - Darshana M Dadhania
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.,Department of Transplantation Medicine, NewYork-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA
| | - Michelle Lubetzky
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.,Department of Transplantation Medicine, NewYork-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA
| | - Simon A Hirota
- Department of Physiology and Pharmacology, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Steven C Greenway
- Departments of Pediatrics and Biochemistry and Molecular Biology, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - John R Lee
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, NY, USA.,Department of Transplantation Medicine, NewYork-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY, USA
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3
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Sivaraj S, Chan A, Pasini E, Chen E, Lawendy B, Verna E, Watt K, Bhat M. Enteric dysbiosis in liver and kidney transplant recipients: a systematic review. Transpl Int 2020; 33:1163-1176. [PMID: 32640109 DOI: 10.1111/tri.13696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/10/2020] [Accepted: 07/03/2020] [Indexed: 12/17/2022]
Abstract
Several factors mediate intestinal microbiome (IM) alterations in transplant recipients, including immunosuppressive (IS) and antimicrobial drugs. Studies on the structure and function of the IM in the post-transplant scenario and its role in the development of metabolic abnormalities, infection, and cancer are limited. We conducted a systematic review to study the taxonomic changes in liver (LT) and kidney (KT) transplantation, and their potential contribution to post-transplant complications. The review also includes pre-transplant taxa, which may play a critical role in microbial alterations post-transplant. Two reviewers independently screened articles, and assessed risk of bias. The review identified 13 clinical studies, which focused on adult kidney and liver transplant recipients. Patient characteristics and methodologies varied widely between studies. Ten studies reported increased an abundance of opportunistic pathogens (Enterobacteriaceae, Enterococcaceae, Fusobacteriaceae, and Streptococcaceae) followed by butyrate-producing bacteria (Lachnospiraceae and Ruminococcaceae) in nine studies in post-transplant conditions. The current evidence is mostly based on observational data and studies with no proof of causality. Therefore, further studies exploring the bacterial gene functions rather than taxonomic changes alone are in demand to better understand the potential contribution of the IM in post-transplant complications.
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Affiliation(s)
- Saranya Sivaraj
- Multi Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Anita Chan
- Multi Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Elisa Pasini
- Multi Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Emily Chen
- Multi Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Bishoy Lawendy
- Multi Organ Transplant Program, University Health Network, Toronto, ON, Canada
| | - Elizabeth Verna
- Division of Digestive and Liver Diseases, Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, NY, USA
| | - Kymberly Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Mamatha Bhat
- Multi Organ Transplant Program, University Health Network, Toronto, ON, Canada.,Division of Gastroenterology and Hepatology, University Health Network and University of Toronto, Toronto, ON, Canada
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