The role of the human microbiome in health and disease is becoming increasingly apparent. Emerging evidence suggests that the microbiome is affected by solid organ transplantation. Kidney transplantation is the gold standard treatment for End-Stage Renal Disease (ESRD), the advanced stage of Chronic Kidney Disease (CKD). The question of how ESRD and transplantation affect the microbiome and vice versa includes how the microbiome is affected by increased concentrations of toxins such as urea and creatinine (which are elevated in ESRD), whether restoration of renal function following transplantation alters the composition of the microbiome, and the impact of lifelong administration of immunosuppressive drugs on the microbiome. Changes in microbiome composition and activity have been reported in ESRD and in therapeutic immunosuppression, but the effect on the outcome of transplantation is not well-understood. Here, we consider the current evidence that changes in kidney function and immunosuppression following transplantation influence the oral, gut, and urinary microbiomes in kidney transplant patients. The potential for changes in these microbiomes to lead to disease, systemic inflammation, or rejection of the organ itself is discussed, along with the possibility that restoration of kidney function might re-establish orthobiosis.

人类微生物组在健康和疾病中的作用越来越明显。新兴证据表明，微生物组受实体器官移植的影响。肾脏移植是终末期肾脏疾病（ESRD）（慢性肾脏病（CKD）的晚期）的金标准治疗。ESRD和移植如何影响微生物组和反之亦然包括微生物组如何受到诸如尿素和肌酐等毒素浓度升高（在ESRD中升高）的影响，移植后肾功能的恢复是否会改变微生物组的组成，以及终身使用免疫抑制剂对微生物组的影响。在ESRD和治疗性免疫抑制中已经报道了微生物组组成和活性的变化，但是对移植结果的影响尚不清楚。在这里，我们考虑目前的证据，即移植后肾脏功能和免疫抑制的变化会影响肾脏移植患者的口腔，肠道和泌尿微生物组。讨论了这些微生物组变化导致疾病，全身性炎症或器官自身排斥的可能性，