Our understanding of the involvement of the gut microbiota (GM) in human health has expanded exponentially over the last few decades, particularly in the fields of metabolism, inflammation, and immunology. Immunosuppressive treatment (IST) prescribed to solid organ transplant (SOT) recipients produces GM changes that affect these different processes. This review aims at describing the current knowledge of how IST changes the GM. Overall, SOT followed by IST results in persistent changes in the GM, with a consistent increase in proteobacteria including opportunistic pathobionts. In mice, Tacrolimus induces dysbiosis and metabolic disorders, and alters the intestinal barrier. The transfer of the GM from Tacrolimus-treated hosts confers immunosuppressive properties, suggesting a contributory role for the GM in this drug's efficacy. Steroids induce dysbiosis and intestinal barrier alterations, and also seem to depend partly on the GM for their immunosuppressive and metabolic effects. Mycophenolate Mofetil, frequently responsible for digestive side effects such as diarrhea and colitis, is associated with pro-inflammatory dysbiosis and increased endotoxemia. Alemtuzumab, m-TOR inhibitors, and belatacept have shown more marginal impact on the GM. Most of these observations are descriptive. Future studies should explore the underlying mechanism of IST-induced dysbiosis in order to better understand their efficacy and safety characteristics.

中文翻译：

---

实体器官移植后的免疫抑制治疗和肠道菌群：与临床后果的双向相互作用

在过去的几十年里，我们对肠道微生物群 (GM) 在人类健康中的作用的理解呈指数增长，特别是在新陈代谢、炎症和免疫学领域。对实体器官移植 (SOT) 接受者规定的免疫抑制治疗 (IST) 会产生影响这些不同过程的 GM 变化。本综述旨在描述关于 IST 如何改变 GM 的当前知识。总的来说，SOT 之后是 IST 会导致 GM 持续变化，包括机会致病菌在内的变形菌持续增加。在小鼠中，他克莫司会引起生态失调和代谢紊乱，并改变肠道屏障。从他克莫司处理的宿主转移 GM 具有免疫抑制特性，表明 GM 在该药物的功效中发挥了促进作用。类固醇会导致生态失调和肠道屏障改变，并且似乎也部分依赖于 GM 的免疫抑制和代谢作用。霉酚酸酯经常导致腹泻和结肠炎等消化系统副作用，与促炎性生态失调和内毒素血症增加有关。Alemtuzumab、m-TOR 抑制剂和 belatacept 对 GM 的影响较小。大多数这些观察是描述性的。未来的研究应该探索 IST 诱导的生态失调的潜在机制，以便更好地了解它们的有效性和安全性特征。与促炎性生态失调和内毒素血症增加有关。Alemtuzumab、m-TOR 抑制剂和 belatacept 对 GM 的影响较小。大多数这些观察是描述性的。未来的研究应该探索 IST 诱导的生态失调的潜在机制，以便更好地了解它们的有效性和安全性特征。与促炎性生态失调和内毒素血症增加有关。Alemtuzumab、m-TOR 抑制剂和 belatacept 对 GM 的影响较小。大多数这些观察是描述性的。未来的研究应该探索 IST 诱导的生态失调的潜在机制，以便更好地了解它们的有效性和安全性特征。