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Probiotic use in pediatric kidney transplant recipients: What are current practices, and are they evidence-based? A
S J Kizilbash1, H Connolly2, S Bartosh3
1Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
Insights
Pediatric nephrologists increasingly prescribe probiotics for kidney transplant recipients, but practice varies widely. Lack of safety data is a major concern, limiting widespread use in this vulnerable population.
Area of Science:
- Microbiology
- Pediatric Nephrology
- Transplantation
Background:
- Probiotics, beneficial live microorganisms, have limited research in transplant recipients.
- Understanding current practices is crucial for optimizing care in pediatric kidney transplant patients.
Purpose of the Study:
- To investigate the current practices and variations among pediatric nephrologists regarding probiotic use in pediatric kidney transplant recipients.
- To identify the primary indications and concerns associated with probiotic prescription in this patient group.
Main Methods:
- A multi-center survey using a 10-item questionnaire was administered to pediatric nephrologists.
- The survey was conducted in April 2023 among participants of the Pediatric Nephrology Research Consortium meeting.
Main Results:
- 42.2% of 64 surveyed pediatric nephrologists prescribed probiotics, primarily for antibiotic-associated diarrhea and Clostridium difficile infections.
- Concerns about safety data were reported by 20 respondents, influencing prescription decisions.
- Prescribing practices varied, with some holding probiotics during neutropenia or central venous line use.
Conclusions:
- Pediatric nephrologists are increasingly using probiotics in kidney transplant recipients, yet significant practice variations persist.
- The limited availability of robust safety data is a key barrier to the broader adoption of probiotics in this population.
- Further research is needed to establish clear guidelines for probiotic use in pediatric kidney transplant care.
Background:
Probiotics are living microorganisms that may confer health benefits to their host if administered in sufficient quantities. However, data on the use of probiotics in transplant recipients are scarce.
Method:
This multi-center survey of pediatric nephrologists aimed to examine variations in practice regarding the use of probiotics in pediatric kidney transplant recipients. The survey was conducted via a 10-item questionnaire (developed in Survey Monkey) administered to pediatric nephrologists participating in the Pediatric Nephrology Research Consortium meeting in April 2023.
Results:
Sixty-four pediatric nephrologists completed the survey. Twenty-seven (42.2%) respondents reported having prescribed probiotics to pediatric kidney transplant recipients. The primary reason for probiotic use was the treatment of antibiotic-associated diarrhea (n = 20), with other reasons including recurrent Clostridium difficile infection (n = 15), general gut health promotion (n = 12), recurrent urinary tract infections (n = 8), and parental request (n = 1). Of those who prescribed probiotics, 48.1% held them during periods of neutropenia and 14.8% during central venous line use. Of the 64 respondents, 20 reported the lack of safety data as a concern for using probiotics in kidney transplant recipients.
Conclusion:
Pediatric nephrologists are increasingly prescribing probiotics to pediatric kidney transplant recipients; nevertheless, substantial practice variations exist. The paucity of safety data is a significant deterrent to probiotic use in this population.
