Abstract
Renal transplant recipients (RTRs) often suffer from posttransplant diarrhea. The observed dysbiosis in RTR may influence the fermentation processes in the gut. In this study, we aimed to investigate whether fermentation differs between RTRs and healthy controls (HCs), by measuring breath H2 and CH4 concentrations. Additionally, we determined the fecal presence of the methanogen Methanobrevibacter smithii (M. smithii), which plays a main role in the process of methanogenesis. Data from the TransplantLines Biobank and Cohort Study (NCT03272841) was used. A total of 142 RTRs and 77 HCs were included. Breath H2 concentrations in RTRs were not significantly different from HCs. Breath CH4 concentrations in RTRs were significantly lower compared with HCs (median [interquartile range (IQR)] 7.5 [3.9–10.6] ppm vs. 16.0 [8.0–45.5] ppm, p < 0.001). M. smithii was less frequently present in the feces of RTRs compared to HCs (28.6% vs. 86.4% resp., p < 0.001). Our findings regarding the altered methanogenesis in the gut of RTRs show similarities with previous results in inflammatory bowel disease patients. These findings provide novel insight into the alterations of fermentation after renal transplantation, which may contribute to understanding the occurrence of posttransplant diarrhea.
Highlights
Renal transplantation is the preferred treatment for patients with end-stage renal disease [1,2,3]
We have shown that no significant difference in breath H2 concentration was found between renal transplant recipients (RTRs) and healthy controls (HCs), breath CH4 concentrations were significantly lower in the RTRs compared with the HCs
The study shows that breath CH4 concentration and the prevalence of M. smithii in feces are significantly lower in RTRs compared to HCs
Summary
Renal transplantation is the preferred treatment for patients with end-stage renal disease [1,2,3]. Patients often experience gastrointestinal complaints such as diarrhea, which is associated with premature kidney allograft failure and mortality, and which affects quality of life [5,6]. This posttransplant diarrhea is believed to be non-infectious and induced by the use of medication [5,7]. RTRs with diarrhea had a lower diversity of commensal bacterial taxa in the gut, creating a dysfunctional metabolic state. These commensal bacterial taxa are important for the degradation of complex molecules such as complex carbohydrates. These complex polymers are fermented to short-chain fatty acids (acetate, butyrate and propionate) and gases (hydrogen (H2) and carbon dioxide (CO2)) [10]
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