Gut microbiome alterations precede organ rejection in kidney transplantation patients

Kidney transplantation is the most effective treatment for patients with end-stage kidney disease. Despite advancements, managing graft rejection, which significantly affects graft and patient survival, remains a critical challenge. This study focuses on the role of the gut microbiome, a key immune system modulator, in kidney transplant outcomes.Chronic kidney disease (CKD) patients exhibit significant changes in their gut microbiota, often resulting in an imbalance that affects metabolic processes and immune responses. After transplantation, these microbiome alterations may persist, potentially influenced by immunosuppressive therapy, and can impact transplant outcomes such as graft rejection and patient morbidity.This longitudinal study analyzed the gut microbiome's composition and function in recipients of kidney transplants from the German Center of Infectious Diseases (DZIF) transplant cohort. The study aimed to connect microbiome dynamics with clinical outcomes, focusing on graft survival and rejection.Participants were selected from a multicenter prospective cohort across five major German transplant centers, covering a substantial portion of the countrys transplant activity. The study excluded multi-organ transplant recipients and previous organ transplant patients. Ethical approval was secured from all centers, and informed consent was obtained from all participants.Fecal samples were collected in a DNA stabilizing buffer at specified intervals post-transplant and during clinical events such as infections or rejection episodes. The 16S rRNA gene sequencing was performed to assess microbial diversity and dynamics.