The five-year study builds off a pilot study that pointed to an association between changes in the gut microbiome and pain that interferes with a person’s daily activities, a symptom that nearly half of kidney transplant patients experience.
“The goal of a kidney transplantation is to get people back to work, back to participating in activities in their community and spending quality time with their families,” explained Mark Lockwood, associate professor in the College of Nursing, who will lead the study. “But there are a significant number of transplant recipients who continue to have symptoms like pain, fatigue, trouble sleeping, depression and anxiety that can negatively affect their quality of life.”
There are many reasons that the gut microbiome may change after a kidney transplant, Lockwood said. It could be due to a change of diet — kidney patients on dialysis are generally on a heavily restricted diet and then they are able to expand their culinary options post-transplant. Or it could be tied to the immunosuppressive medications that transplant patients need to take for life. There’s also a lot of stress involved post-transplant for many patients who feel a great responsibility to take care of the kidney they’ve been given. The research team is hoping to gain more understanding of the processes at work in their study.
For the new study, the team will enroll 120 kidney recipients who will submit samples to assess their gut microbiome before the surgery and monthly for six months post-surgery. Participants also will complete surveys to determine the severity of symptoms, level of stress and how their kidney disease impacts their quality of life. The research team will do a detailed dietary assessment before surgery and at three and six months post-surgery, as nutrition is well known to affect the gut microbiome.
For logistical reasons, the study is only enrolling people who are getting live kidney donations, since those patients have their surgeries scheduled ahead of time. But Lockwood said they would like to eventually expand into nonliving donor transplant recipients, as they may have an even higher burden from symptoms due to extended time on dialysis.
The goal is to better understand the mechanisms that cause symptoms that affect a person’s quality of life. The gut microbiome is a particularly promising line of study because previous research has shown that the it is very responsive to changes in diet, physical activity and stress, Lockwood explained.
“The microbes in the gut play an important role in health and disease,” Lockwood said. “By understanding the effects of nutrition, stress and medications required to maintain the transplanted kidney on the composition and function of the gut microbes, we may be able to develop individualized treatment plans to reduce symptom burden and improve quality of life.”
The grant is from the National Institute of Diabetes and Digestive and Kidney Diseases. The other researchers on the study are Dr. Mario Spaggiari and Beatriz Peñalver Bernabé in the College of Medicine, Ardith Doorenbos and Chang Park in the College of Nursing, Lisa Tussing-Humphreys in the College of Applied Health Sciences, as well as Stefan Green from Rush University.