Pain Interference in End Stage Kidney Disease is Associated with Changes in Gut Microbiome Features Before and After Kidney Transplantation

Background: Pain, a common debilitating symptom among kidney transplant recipients (KTRs), is among the most common and undertreated symptoms after kidney transplantation.Aims: Characterize associations between gut microbiome features and pain interference before and after kidney transplantation. Design: Longitudinal, repeated measures study, collecting fecal specimens and pain interference data pretransplant and 3 months posttransplant.Setting: Participants were recruited at the kidney transplant clinic at the University of Illinois Hospital & Health Sciences System. Participants/subjects: 19 living donor kidney transplant recipients. Methods: We assessed fecal microbial community structure with shotgun metagenomic sequencing; we used pain interference scores derived from the Patient-Reported Outcomes Measurement Information System-57.Results: We measured a reduction in the Shannon diversity index in both groups after transplantation but observed no significant differences between groups at either time point. We did observe significant differences in fecal microbial Bray-Curtis similarity index among those reporting pain interference pre -transplant versus no pain interference at 3-months posttransplant ( R = .306, p = .022), and between pain interference groups at posttransplant ( R = .249, p = .041). Pairwise models showed significant differences between groups posttransplant in relative abundances of several taxa, including a 5-fold reduction in Akkermansia among those with pain interference and a higher relative abundance of taxa associated with chronic inflammation in those with pain interference posttransplant. Functional gene analysis identified two features that were significantly enriched in those with pain interference, including a peptide trans-port system gene.Conclusions: Gut microbiota community structure differs between groups with and without pain inter-ference at 3 months after kidney transplantation. Several taxa involved in intestinal barrier integrity and chronic inflammation were associated with posttransplant pain. (c) 2022 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Automated summary

This study aimed to explore the associations between gut microbiome features and pain interference before and after kidney transplantation. The researchers collected fecal specimens and pain interference data from 19 living donor kidney transplant recipients. The results showed that the gut microbiota community structure differed between groups with and without pain interference at 3 months after transplantation. Additionally, certain taxa associated with intestinal barrier integrity and chronic inflammation were found to be related to posttransplant pain.