*Purpose: New-onset diabetes transplantation after transplantation (NODAT) is an important metabolic complication after kidney transplantation, although its mechanism is not yet fully elucidated. Recent studies have suggested that gut bacteria play a fundamental role in diabetes of general population. We aimed to investigate the effect of the gut microbiota on NODAT in kidney recipients.

*Methods: Stool samples were collected from 46 transplant recipients at three different time point: before transplantation, 3 months after transplantation and 12 months after transplantation. Stool DNA extraction and 16s DNA metagenome sequencing were performed. The development of PTDM is defined as Hb A1c level 6.5% or higher or the starting use of diabetes medications

*Results: Of the 46 transplant patients, 11 were diagnosed with pre-transplant DM, and among the remaining 35 patients, 15 were diagnosed with NODAT during the follow-up period of 2.1 ± 0.3 years. In the 16s DNA analysis, non-DM, NODAT, and pre-transplant DM patients were showed significantly different in change of abundance in genus Veillonella according to the time after transplant. Proportion of Veillonella increased significantly at 3 months compared to pre-transplant in non-DM recipients, but neither in patients with NODAT nor pre-transplant DM. In addition, patients with reduced abundance of Veillonella at 3 months post-transplant compared to pre-transplantation had a 6.0-fold increased risk of developing NODAT compared to those without (unadjusted hazard ratio 6.00, 95% confidence interval 1.87-19.2, P =0.003; age, sex, body mass index, dialysis duration and desensitization-adjusted hazard ratio 5.85, 95% confidence interval 1.61-21.28 P =0.007).

*Conclusions: The reduction of Veillonella at 3 months after transplantation is significantly associated with risk of NODAT.

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