Introduction. Post-transplant diarrhea is a frequent complication after kidney transplantation but its etiology is unknown in the majority of cases; herein, we investigated whether post-transplant diarrhea is associated with gut microbial dysbiosis.

Methods. We prospectively collected serial fecal specimens from 71 kidney transplant recipients, and profiled their gut microbiota using 16S rRNA deep sequencing of the V4-V5 hypervariable region. Among the 71 patients, 24 developed post-transplant diarrhea in the first 3 months after transplantation (Diarrhea Cohort) and 47 did not (No Diarrhea Cohort). We compared the microbial profiles of 29 diarrhea-associated fecal specimens from the Diarrhea Cohort to the profiles in 119 non-diarrhea associated fecal specimens from the No Diarrhea Cohort.

Results. Shannon diversity index was significantly lower in the Diarrhea Cohort than the No Diarrhea Cohort (mean 3.0±0.7 vs. 3.6±0.5, P<0.001, Wilcoxon rank sum test). At the genus level, 13 commensal genera were significantly lower in the Diarrhea Cohort than the No Diarrhea Cohort (q value<0.15, Benjamini-Hochberg correction). Within the Diarrhea Cohort. 93% of specimens were negative using a multiplex PCR array of diarrheal-associated pathogens (BioFire GI Film Array). Predicted metagenomics using PICRUSt suggested distinct functional pathways decreased in the Diarrhea Cohort, particularly metabolic functional pathways.Conclusions. Our identification of lower abundance of commensal bacteria and associated impaired metabolism represent plausible pathways for post-transplant diarrhea, which supports future studies targeting the gut microbiota to prevent and/or treat post-transplant diarrhea.

CITATION INFORMATION: Lee J, Mcgruder M, Zhang L, Thangamani M, Dadhania D, Westblade L, Satlin M, Robertson A, Ling L, Taur Y, Pamer E, Suthanthiran M. On the Pathogenesis of Post-Transplant Diarrhea in Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress