Pretransplant Gut Microbiome Signatures Predict Early Acute Rejection After Kidney Transplantation.
Analyzing gut bacteria before kidney transplant identifies patients at higher risk for rejection, enabling targeted monitoring to catch problems earlier.
In a cohort of 78 kidney transplant recipients, shotgun metagenomic sequencing of pretransplant stool identified microbiome signatures (including mcmB propionate biosynthesis) that predicted early acute rejection with AUC improving stepwise from 0.565 to 0.765 in temporal validation. Microbiome-augmented random forest models showed net clinical benefit at decision thresholds 0.2–0.5, supporting pretransplant gut microbiome profiling as a novel risk stratification tool to guide early post-transplant monitoring.
What the study was
- Study design
- Prospective cohort with temporal validation
- Population
- 78 kidney transplant recipients; stool samples collected pretransplant; 26 (33.3%) developed biopsy-proven early acute rejection
- Sample size
- 78
- Category
- Diagnostics
- Maturity
- Validated
- Journal
- American Journal of Transplantation
Why it surfaced
Pretransplant microbiome testing is a clinically actionable and novel risk stratification approach validated in a temporal cohort; AUC 0.765 with improved reclassification metrics over clinical-only models addresses unmet need in transplant rejection prediction.
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