{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:27:24Z","timestamp":1793316444319,"version":"4.5.0"},"reference-count":56,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T00:00:00Z","timestamp":1674172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union","award":["860329"],"award-info":[{"award-number":["860329"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biology"],"abstract":"<jats:p>Kidney transplantation improves quality of life, morbidity, and mortality of patients with kidney failure. However, integrated immunosuppressive therapy required to preserve graft function is associated with the development of post-transplant complications, including infections, altered immunosuppressive metabolism, gastrointestinal toxicity, and diarrhea. The gut microbiota has emerged as a potential therapeutic target for personalizing immunosuppressive therapy and managing post-transplant complications. This review reports current evidence on gut microbial dysbiosis in kidney transplant recipients, alterations in their gut microbiota associated with kidney transplantation outcomes, and the application of gut microbiota intervention therapies in treating post-transplant complications.<\/jats:p>","DOI":"10.3390\/biology12020163","type":"journal-article","created":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T02:35:55Z","timestamp":1674182155000},"page":"163","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["The Gut Microbiota in Kidney Transplantation: A Target for Personalized Therapy?"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4184-6219","authenticated-orcid":false,"given":"Yuselys","family":"Garc\u00eda-Mart\u00ednez","sequence":"first","affiliation":[{"name":"Department of Translational Medical Science, University of Campania \u201cLuigi Vanvitelli\u201d, Via Pansini, Bldg 17, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margherita","family":"Borriello","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, Via L. De Crecchio 7, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Capolongo","sequence":"additional","affiliation":[{"name":"Department of Translational Medical Science, University of Campania \u201cLuigi Vanvitelli\u201d, Via Pansini, Bldg 17, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Ingrosso","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine, University of Campania \u201cLuigi Vanvitelli\u201d, Via L. 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(2015). Gut Microbiota and Tacrolimus Dosing in Kidney Transplantation. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0122399"},{"key":"ref_3","unstructured":"(2022, October 05). Transplant Recipient\u2013KDIGO. Available online: https:\/\/kdigo.org\/guidelines\/transplant-recipient\/."},{"key":"ref_4","first-page":"1401","article-title":"Gut Microbiota in Renal Transplant Recipients, Patients with Chronic Kidney Disease and Healthy Subjects","volume":"38","author":"Guirong","year":"2018","journal-title":"Nan Fang Yi Ke Da Xue Xue Bao"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Swarte, J.C., Douwes, R.M., Hu, S., Vich Vila, A., Eisenga, M.F., van Londen, M., Gomes-Neto, A.W., Weersma, R.K., Harmsen, H.J.M., and Bakker, S.J.L. (2020). Characteristics and Dysbiosis of the Gut Microbiome in Renal Transplant Recipients. J. Clin. Med., 9.","DOI":"10.3390\/jcm9020386"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Souai, N., Zidi, O., Mosbah, A., Kosai, I., Manaa, J.E., Mokhtar, N.B., Asimakis, E., Stathopoulou, P., Cherif, A., and Tsiamis, G. (2020). Impact of the Post-Transplant Period and Lifestyle Diseases on Human Gut Microbiota in Kidney Graft Recipients. Microorganisms, 8.","DOI":"10.3390\/microorganisms8111724"},{"key":"ref_7","first-page":"697","article-title":"Gut Microbial Community Structure and Complications Following Kidney Transplantation: A Pilot Study","volume":"98","author":"Lee","year":"2014","journal-title":"Transplantation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"105191","DOI":"10.1016\/j.micpath.2021.105191","article-title":"The Alteration Human of Gut Microbiota and Metabolites before and after Renal Transplantation","volume":"160","author":"Yu","year":"2021","journal-title":"Microb. Pathog."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1111\/nep.13853","article-title":"Characteristics of the Gastrointestinal Microbiota in Paired Live Kidney Donors and Recipients","volume":"26","author":"Chan","year":"2021","journal-title":"Nephrology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2473","DOI":"10.1007\/s00253-020-11069-x","article-title":"Gut Microbiota Alterations Associated with Antibody-Mediated Rejection after Kidney Transplantation","volume":"105","author":"Wang","year":"2021","journal-title":"Appl. Microbiol. Biotechnol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1124\/dmd.118.084772","article-title":"Commensal Gut Bacteria Convert the Immunosuppressant Tacrolimus to Less Potent Metabolites","volume":"47","author":"Guo","year":"2019","journal-title":"Drug Metab. Dispos."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/TXD.0000000000001052","article-title":"Blood Profiles of Gut Bacterial Tacrolimus Metabolite in Kidney Transplant Recipients","volume":"6","author":"Guo","year":"2020","journal-title":"Transplant. Direct"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1111\/ajt.12588","article-title":"Human Microbiota Characterization in the Course of Renal Transplantation","volume":"14","author":"Fricke","year":"2014","journal-title":"Am. J. Transplant."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5521","DOI":"10.1038\/s41467-019-13467-w","article-title":"Gut Uropathogen Abundance Is a Risk Factor for Development of Bacteriuria and Urinary Tract Infection","volume":"10","author":"Magruder","year":"2019","journal-title":"Nat. Commun."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1805281","DOI":"10.1080\/19490976.2020.1805281","article-title":"Gut Commensal Microbiota and Decreased Risk for Enterobacteriaceae Bacteriuria and Urinary Tract Infection","volume":"12","author":"Magruder","year":"2020","journal-title":"Gut Microbes"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e13180","DOI":"10.1111\/tid.13180","article-title":"Butyrate-Producing Gut Bacteria and Viral Infections in Kidney Transplant Recipients: A Pilot Study","volume":"21","author":"Lee","year":"2019","journal-title":"Transpl. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1111\/ajt.14974","article-title":"Gut Microbiota Dysbiosis and Diarrhea in Kidney Transplant Recipients","volume":"19","author":"Lee","year":"2019","journal-title":"Am. J. Transplant."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e14260","DOI":"10.1111\/ctr.14260","article-title":"Gut Microbiota Profiles and Fecal Beta-Glucuronidase Activity in Kidney Transplant Recipients with and without Post-Transplant Diarrhea","volume":"35","author":"Zhang","year":"2021","journal-title":"Clin. Transplant."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lecronier, M., Tashk, P., Tamzali, Y., Tenaillon, O., Denamur, E., Barrou, B., Aron-Wisnewsky, J., and Tourret, J. (2020). Gut Microbiota Composition Alterations Are Associated with the Onset of Diabetes in Kidney Transplant Recipients. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0227373"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.biopha.2017.02.114","article-title":"Gut Microbiota and Renal Transplant Outcome","volume":"90","author":"Ardalan","year":"2017","journal-title":"Biomed. Pharmacother."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"eaax2358","DOI":"10.1126\/sciadv.aax2358","article-title":"Vancomycin Relieves Mycophenolate Mofetil-Induced Gastrointestinal Toxicity by Eliminating Gut Bacterial \u03b2-Glucuronidase Activity","volume":"5","author":"Taylor","year":"2019","journal-title":"Sci. Adv."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Stripling, J., Kumar, R., Baddley, J.W., Nellore, A., Dixon, P., Howard, D., Ptacek, T., Lefkowitz, E.J., Tallaj, J.A., and Benjamin, W.H. (2015). Loss of Vancomycin-Resistant Enterococcus Fecal Dominance in an Organ Transplant Patient With Clostridium Difficile Colitis After Fecal Microbiota Transplant. Open Forum Infect. Dis., 2.","DOI":"10.1093\/ofid\/ofv078"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1007\/s15010-018-1190-9","article-title":"Fecal Microbiota Transplantation in a Kidney Transplant Recipient with Recurrent Urinary Tract Infection","volume":"46","author":"Biehl","year":"2018","journal-title":"Infection"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1159\/000502336","article-title":"Faecal Microbiota Transplantation Eradicated Extended-Spectrum Beta-Lactamase-Producing Klebsiella Pneumoniae from a Renal Transplant Recipient with Recurrent Urinary Tract Infections","volume":"9","author":"Grosen","year":"2019","journal-title":"Case Rep. Nephrol. Dial."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.2147\/IDR.S308308","article-title":"Fecal Microbiota Transplantation as an Effective Treatment for Carbapenem-Resistant Klebsiella Pneumoniae Infection in a Renal Transplant Patient","volume":"14","author":"Wang","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1111\/ajt.16836","article-title":"Immunosuppressive Therapy after Solid Organ Transplantation and the Gut Microbiota: Bidirectional Interactions with Clinical Consequences","volume":"22","author":"Gabarre","year":"2022","journal-title":"Am. J. Transplant."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1093\/infdis\/jir277","article-title":"Bacteroides Fragilis\u2013Stimulated Interleukin-10 Contains Expanding Disease","volume":"204","author":"McLoughlin","year":"2011","journal-title":"J. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"12204","DOI":"10.1073\/pnas.0909122107","article-title":"Inducible Foxp3+ Regulatory T-Cell Development by a Commensal Bacterium of the Intestinal Microbiota","volume":"107","author":"Round","year":"2010","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1038\/nri3227","article-title":"Regulatory Immune Cells in Transplantation","volume":"12","author":"Wood","year":"2012","journal-title":"Nat. Rev. Immunol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/bs.aambs.2016.06.002","article-title":"The Role of the Gut Microbiome on Chronic Kidney Disease","volume":"96","author":"Pestana","year":"2016","journal-title":"Adv. Appl. Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1007\/s10620-014-3287-z","article-title":"Gut Microbial Translocation in the Pathogenesis of Systemic Inflammation in Patients with End-Stage Renal Disease","volume":"59","author":"Vaziri","year":"2014","journal-title":"Dig. Dis. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1136\/gutjnl-2019-319766","article-title":"Aberrant Gut Microbiota Alters Host Metabolome and Impacts Renal Failure in Humans and Rodents","volume":"69","author":"Wang","year":"2020","journal-title":"Gut"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/MOT.0000000000000262","article-title":"Mechanisms of Antibody-Mediated Acute and Chronic Rejection of Kidney Allografts","volume":"21","author":"Baldwin","year":"2016","journal-title":"Curr. Opin. Organ Transplant."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Hansrivijit, P., Leeaphorn, N., Acharya, P., Torres-Ortiz, A., Kaewput, W., Kovvuru, K., Kanduri, S.R., Bathini, T., and Cheungpasitporn, W. (2020). Recent Advances and Clinical Outcomes of Kidney Transplantation. J. Clin. Med., 9.","DOI":"10.3390\/jcm9041193"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Glorieux, G., Gryp, T., and Perna, A. (2020). Gut-Derived Metabolites and Their Role in Immune Dysfunction in Chronic Kidney Disease. Toxins, 12.","DOI":"10.3390\/toxins12040245"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Gryp, T., Huys, G.R.B., Joossens, M., van Biesen, W., Glorieux, G., and Vaneechoutte, M. (2020). Isolation and Quantification of Uremic Toxin Precursor-Generating Gut Bacteria in Chronic Kidney Disease Patients. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21061986"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Flores-Guerrero, J.L., Ost\u00e9, M.C.J., Baraldi, P.B., Connelly, M.A., Garcia, E., Navis, G., Bakker, S.J.L., and Dullaart, R.P.F. (2021). Association of Circulating Trimethylamine N-Oxide and Its Dietary Determinants with the Risk of Kidney Graft Failure: Results of the TransplantLines Cohort Study. Nutrients, 13.","DOI":"10.3390\/nu13010262"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.transproceed.2011.11.023","article-title":"Serum Total P-Cresol and Indoxyl Sulfate Correlated With Stage of Chronic Kidney Disease in Renal Transplant Recipients","volume":"44","author":"Huang","year":"2012","journal-title":"Transplant. Proc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1080\/07315724.2017.1334602","article-title":"Effect of a Short-Course Treatment with Synbiotics on Plasma p-Cresol Concentration in Kidney Transplant Recipients","volume":"36","author":"Guida","year":"2017","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1253\/circj.CJ-15-0949","article-title":"Levels of Indoxyl Sulfate in Kidney Transplant Patients, and the Relationship With Hard Outcomes","volume":"80","author":"Liabeuf","year":"2016","journal-title":"Circ. J."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Liabeuf, S., Laville, S.M., Glorieux, G., Cheddani, L., Brazier, F., Beauport, D.T., Valholder, R., Choukroun, G., and Massy, Z.A. (2020). Difference in Profiles of the Gut-Derived Tryptophan Metabolite Indole Acetic Acid between Transplanted and Non-Transplanted Patients with Chronic Kidney Disease. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21062031"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"794","DOI":"10.3389\/fcimb.2020.558644","article-title":"Does the Microbiome Affect the Outcome of Renal Transplantation?","volume":"10","author":"Campbell","year":"2020","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"18881","DOI":"10.1038\/s41598-020-76072-8","article-title":"Effect of the Similarity of Gut Microbiota Composition between Donor and Recipient on Graft Function after Living Donor Kidney Transplantation","volume":"10","author":"Kim","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/TP.0000000000001444","article-title":"The Microbiome and Immune Regulation after Transplantation","volume":"101","author":"Tabibian","year":"2017","journal-title":"Transplantation"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1097\/MOT.0000000000000702","article-title":"Impact of the Microbiota on Solid Organ Transplant Rejection","volume":"24","author":"Sepulveda","year":"2019","journal-title":"Curr. Opin. Organ Transplant."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1089\/jir.2019.0011","article-title":"Mechanisms by Which the Gut Microbiota Influences Cytokine Production and Modulates Host Inflammatory Responses","volume":"39","author":"Mendes","year":"2019","journal-title":"J. Interferon Cytokine Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/j.cell.2016.10.020","article-title":"Linking the Human Gut Microbiome to Inflammatory Cytokine Production Capacity","volume":"167","author":"Schirmer","year":"2016","journal-title":"Cell"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.ekir.2020.10.013","article-title":"Patient-Reported Gastrointestinal Symptoms and the Association With Quality of Life Following Kidney Transplantation","volume":"6","author":"Chan","year":"2021","journal-title":"Kidney Int. Rep."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/01.tp.0000225760.09969.1f","article-title":"Mycophenolate Mofetil Dose Reductions and Discontinuations after Gastrointestinal Complications Are Associated with Renal Transplant Graft Failure","volume":"82","author":"Bunnapradist","year":"2006","journal-title":"Transplantation"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e12828","DOI":"10.1111\/tid.12828","article-title":"The Challenge of Urinary Tract Infections in Renal Transplant Recipients","volume":"20","author":"Hollyer","year":"2018","journal-title":"Transpl. Infect. Dis."},{"key":"ref_51","first-page":"2978","article-title":"Impact of Gut Colonization with Butyrate-Producing Microbiota on Respiratory Viral Infection Following Allo-HCT","volume":"131","author":"Haak","year":"2018","journal-title":"Blood"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1053\/j.ajkd.2007.11.013","article-title":"Incidence and Risk Factors for Diarrhea Following Kidney Transplantation and Association With Graft Loss and Mortality","volume":"51","author":"Bunnapradist","year":"2008","journal-title":"Am. J. Kidney Dis."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e13866","DOI":"10.1111\/petr.13866","article-title":"The Gut Microbiome in Solid Organ Transplantation","volume":"24","author":"Zeller","year":"2020","journal-title":"Pediatr. Transplant."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Dudzicz, S., Kujawa-Szewieczek, A., Kwiecie\u0144, K., Wi\u0119cek, A., and Adamczak, M. (2018). Lactobacillus Plantarum 299v Reduces the Incidence of Clostridium Difficile Infection in Nephrology and Transplantation Ward-Results of One Year Extended Study. Nutrients, 10.","DOI":"10.3390\/nu10111574"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.1073\/pnas.0904055107","article-title":"Generation of Regulatory Dendritic Cells and CD4+Foxp3+ T Cells by Probiotics Administration Suppresses Immune Disorders","volume":"107","author":"Kwon","year":"2010","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1056\/NEJMoa1910437","article-title":"Drug-Resistant E. Coli Bacteremia Transmitted by Fecal Microbiota Transplant","volume":"381","author":"Defilipp","year":"2019","journal-title":"New Engl. J. Med."}],"container-title":["Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-7737\/12\/2\/163\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:11:56Z","timestamp":1760119916000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-7737\/12\/2\/163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,20]]},"references-count":56,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["biology12020163"],"URL":"https:\/\/doi.org\/10.3390\/biology12020163","relation":{},"ISSN":["2079-7737"],"issn-type":[{"value":"2079-7737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,20]]}}}