Microbiota management: a perspective for kidney transplant patients

Area of Science:

• Nephrology
• Gastroenterology
• Immunology

Background:

• Chronic kidney disease (CKD) affects millions globally, with many progressing to end-stage kidney disease (ESKD) requiring transplantation.
• Kidney transplant recipients face risks of graft rejection and complications, partly due to intestinal dysbiosis induced by CKD and immunosuppression.
• Intestinal dysbiosis increases uremic toxins, negatively impacting both native and transplanted kidneys.

Purpose of the Study:

• To review the role of gut microbiota modulation in improving kidney allograft tolerance and function.
• To explore the impact of prebiotics, probiotics, synbiotics, and dietary fiber metabolites on renal health in transplant recipients.

Main Methods:

• Literature review of studies on CKD, intestinal dysbiosis, kidney transplantation, and microbiota-targeted therapies.
• Analysis of experimental and clinical data on the effects of prebiotics, probiotics, synbiotics, and short-chain fatty acids (SCFAs).

Main Results:

• Prebiotics, probiotics, and synbiotics help manage nitrogenous substances, reduce renal inflammation, and improve gastrointestinal symptoms in CKD patients.
• SCFAs like butyrate and acetate from fiber fermentation may enhance renal function and allograft acceptance by inducing T regulatory cells.
• The type of dietary fiber may influence gut health and cancer risk, highlighting the need for specific recommendations.

Conclusions:

• Modulating the gut microbiota through diet and supplements is a promising strategy to enhance kidney allograft tolerance and function.
• Further research is needed to optimize the use of prebiotics, probiotics, synbiotics, and specific fibers for renal transplant recipients.