Weibo Zhong, Runtao Feng, Haoxin Liang, Jianmin Hu, Song Zhou, Ding Liu, Shichao Li, Guorong Liao, Jun Liao, Siqiang Yang, Ya Zhang, Xinyun Xiao, Jun Qian, Hua Chen, Li-pei Fan, Min Li, Ming Zhao, Jianrong Chen, Yongguang Liu
BACKGROUND: The gut microbiota undergoes substantial alterations in kidney transplant recipients, which are linked to postoperative complications and renal function recovery. However, the underlying mechanisms of these associations remain unclear. METHODS: We conducted a prospective, longitudinal cohort study at our center. Fecal samples were collected from 88 kidney transplant recipients at multiple time points before and after surgery. The gut microbiota dynamics were profiled using 16S rRNA sequencing. RESULTS: Significant shifts in gut microbiota diversity and composition were observed following transplantation. At 30 days post-surgery, a significant enrichment of Enterobacteriaceae was associated with an increased risk of urinary tract infections (UTIs) and a concomitant reduction in multiple peripheral blood lymphocyte subsets. While Enterobacteriaceae enrichment was not correlated with renal function, patients with an estimated glomerular filtration rate (eGFR) greater than 30 mL/min/1.73 m² at 30 days post-transplantation exhibited a marked increase in Bifidobacterium. CONCLUSIONS: Our findings suggest that post-transplant enrichment of Enterobacteriaceae may be associated with an increased incidence of UTIs and immune dysregulation. In contrast, Bifidobacterium may play a beneficial role in supporting renal function recovery. These results highlight specific gut microbiota taxa as potential biomarkers or targets for improving outcomes in kidney transplant recipients.