The Gut Microbiota in Kidney Transplantation: A Target for Personalized Therapy?

SIMPLE SUMMARY: Kidney function is compromised by several post-transplant complications associated with immunosuppressive therapy, infections, gastrointestinal toxicity, and graft rejection in kidney transplant patients. Given the ability of the gut microbiota to influence alloimmunity, drug metabolism, infections, and gastrointestinal diseases, we studied the therapeutic potential of the gut microbiota in kidney transplantation. Specific microbial signatures have been associated with graft rejection, mycophenolate mofetil and tacrolimus metabolism, and the development of new-onset diabetes after transplantation. In addition, the abundance of gut enterobacteria has been linked to the development of urinary tract infections, while other microbial populations have a protective role in urinary and respiratory tract infections. The application of microbiota-based therapies such as fecal microbiota transplantation has successfully resolved infection and refractory diarrhea events in these patients. Current data suggest that modulating the gut microbiota could potentially contribute to personalizing immunosuppressive and post-transplant complication therapies to improve graft survival and patients’ quality of life. ABSTRACT: Kidney transplantation improves quality of life, morbidity, and mortality of patients with kidney failure. However, integrated immunosuppressive therapy required to preserve graft function is associated with the development of post-transplant complications, including infections, altered immunosuppressive metabolism, gastrointestinal toxicity, and diarrhea. The gut microbiota has emerged as a potential therapeutic target for personalizing immunosuppressive therapy and managing post-transplant complications. This review reports current evidence on gut microbial dysbiosis in kidney transplant recipients, alterations in their gut microbiota associated with kidney transplantation outcomes, and the application of gut microbiota intervention therapies in treating post-transplant complications.