*Purpose: To characterize relationships between differential relative abundances of taxonomy (genus level) of the gut microbiome and pain interference before and after living donor kidney transplant(LDKT) in a racially/ethnically heterogeneous sample/population.

*Methods: A longitudinal prospective, repeated measures design of 19 LDKT recipients. Fecal microbiome samples were collected pre-transplant and at 3-months post-transplant. Pain interference scores were derived from the Patient Reported Outcomes Measurement System (PROMIS-57).

*Results: Participants were 37% female, 63% from historically underserved populations with a mean age of 46.5. At baseline, 58% of participants reported pain compared to 37% at 3-months post-transplant. Using ANOSIM, significant differences in beta diversity were found at 3 months post-transplant among those with pain vs. no pain (R=0.249, p=0.041) (Figure 1). Significant differences in gut microbiome beta diversity were also observed among those with pain pre-transplant versus those with no pain 3 months post-transplant (R=0.306, p=0.022), In pairwise models adjusted for false discovery rate (FDR), we noted significant differences in the relative abundance of several taxa between those with pain vs. no pain at 3 months post-transplant (Figure 2). There was a 5-fold log² reduction of bacteria from the genus Akkermansia among those with pain. A higher abundance of several taxa that have been associated with conditions involving chronic inflammation (e.g. Mobiluncus, Enterococcus, Actinotigum) were found in those reporting pain at 3-months.

*Conclusions: Community structure of gut microbiota differs between those with and without pain at baseline and at 3-months post-kidney transplantation. Several fecal microbiota taxa involved in intestinal barrier integrity and chronic inflammation were associated with pain at 3-months post-transplant. Interrogation of the role of these microbes in pain is warranted in a larger sample.

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