Monday, September 26, 2022

Are Probiotics Safe For Kidney Transplant Patients

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Eat Many More Whole Foods Than Processed Foods

Ask Mayo Clinic: Kidney Disease

Processed foods include many convenience meal items, like packaged cereal, boxed mac ‘n cheese and frozen pizza. These meals are loaded with artificial ingredients, and although their nutrition labels might say they include healthy nutrients, the nutrients are often artificially added in ways that are more difficult for your body to process.

Whole foods are foods that are not processed at all, like fruits, vegetables, nuts and beans, or foods that are only lightly processed, like whole grain bread or pasta, milk, cheese and tofu. When you cook at home using whole foods, you generally save money, prepare more than a single serving, and enjoy meals good for your gut and kidney health. Check out our many delicious recipes on the American Kidney Fund’s Kidney Kitchen® for tasty meals you can cook using whole food ingredients.

Management Of Cmv Disease: Liver And Renal Transplantation

Recently published clinical trials suggest that symptomatic CMV infection in liver and renal transplantation may be preventable. However, efforts taken to prevent CMV disease should be commensurate with the magnitude of the clinical problem. Suggested strategies for CMV prevention should be subjected to careful costbenefit analysis and the results or interpretation of such analyses may differ between transplant units. For example, a strategy might be deemed appropriate for liver recipients in one transplant centre, but may be inappropriate for renal recipients at another centre.

Taking Probiotics After Liver Transplant

Does anyone have any experience taking probiotics after having a liver transplant. I am almost 4 years post transplant and would like to enhance my gut health and over all health if possible. I currently take tacrolimus and cellcept and wondering if it would be a waste of money or a possible health risk. Ive read mixed information online.

My husband is almost one year post liver transplant. He was told not to take them by his team. I suggest asking your transplant doctor what the best option is for you.Blessings,

@garyandrade This is something I have wondered about also but I never get around to asking my transplant team. Before you do it you should definitely check with someone on your transplant team, as @jodeej suggested.

I will be very interested in hearing what they say. I will be three years post-transplant in September. I am on sirolimus because tacrolimus was causing my creatinine to go high so it may be different depending on what immunosuppressant you are on.JK

Really probiotics are not much different than yogurt, except their more concentrated, and yogurt is fine.

I asked my team this a couple of weeks ago and they told me it was ok to take them but not go overboard. I still havent taken any, Im still eating my yogurt though.

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What Are Some Of The High

It is recommended to avoid foods that are spoiled, moldy or past its use by date, as well as avoid the foods listed below. If you have any questions, talk to your healthcare team.

Meat, fish and poultry

  • Unpasteurized milk, cheese or yogurt
  • Uncooked or undercooked eggs and any products containing them

Fruits and vegetables

  • Grapefruit or grapefruit juice and pomegranate or pomegranate juice especially if you are taking cyclosporine or prograf
  • Unwashed raw fruits and damaged fruits
  • Unwashed raw vegetables and unwashed salads
  • Unpasteurized juices or ciders

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What Type And Dose Of Probiotic Is Best For Infants

Probiotic 100+ Billion CFUs

Most of the infant studies used an infant formula fortified with category 1 probiotics. The exact strains varied from study to study. Dosages varied between studies as well, but 10 billion CFU per day appears a good general starting point. Talk to your pediatrician before choosing a probiotic for your child.

Probiotic Species
L. paracasei and B. lactis

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Urinary Microbiome May Hold Key To Early Rejection Detection

Since the recognition of its medical relevance, the urinary microbiome has been receiving growing attention . The most frequently reported genera are Lactobacillus and Streptococcus, with Alloscardovia, Burkholderia, Jonquetella, Klebsiella, Saccharofermentans, Rhodanobacter, and Veillonella also found less frequently . Whilst the importance of the urinary microbiome in health is still emerging, evidence from several studies confirm its composition is altered by some post-transplant situations . A study comparing the urinary microbiome of 21 kidney transplant recipients with that of 8 healthy controls reported marked differences between the two groups . Under the multiple stressors of kidney transplantation the urinary microbiota of kidney-transplant recipients suggested an overall decrease in diversity when compared to healthy controls, alongside an increased abundance of opportunistic pathogens and may select for promotion of antibiotic resistance. The effect of elevated urinary urea concentrations on urinary tract infections caused by urealytic pathogens also warrants further investigation. In the future, frequent, longitudinal sampling of the patients urinary microbiome might be implemented to detect deviations from microbiome stability. If these changes are shown to precede organ damage or loss, this may be useful as a non-invasive method of early detection.

Intestinal Microbiota And The Kidney

An inter-relationship between the gut and the kidney occurs either by the activation of the immune system or by the microbiota-derived metabolites. While the indigenous resident microbiota induces a normal balance between Treg and Th17 cells, pathobionts may activate Th17 cells and favour renal inflammation and injury.21

Similarly, microbiota-derived metabolites may affect kidney function. The protective role of SCFA has been already highlighted. In addition, SCFA have beneficial effects by reducing the production of cytokines and chemokines such as IL-, IL-6, TNF, and monocyte chemoattractant protein.22

On the contrary, pathobionts such as E. coli have deleterious effects. The phenomenon is bilateral. Indeed, dysbiosis may facilitate acute kidney injury by modifying SCFA composition and generating high quantities of toxic indoxylsulfate and trimethylamine N oxide . This fact may favour the transition from AKI to chronic kidney disease . On the other hand, AKI may modify the gut bacterial composition . 23

Figure 2: Relationship between acute kidney injury, chronic kidney disease, and toxic substances.Dysbiosis may facilitate AKI by modifying the SCFA composition and generating high quantities of toxic indoxysulfate and TMAO.AKI: acute kidney injury CKD: chronic kidney disease CVD: cardiovascular disease LPS: lipopolysaccharides SCFA: short-chain fatty acids TMA: trimethylamine TMAO: trimethylamine N oxide.

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What Happens After A Kidney Transplant

After kidney transplant surgery, your child will spend a few days in the hospital to recover. The health care team will watch closely to make sure there are no complications from the surgery, such as bleeding or infection.

You and your child will learn about the medicines needed to keep the body from rejecting the new kidney. These are called immunosuppressants. Taking them can make your child more likely to get infections, especially in the days right after surgery. So keep your child away from sick people, and have everyone at home wash their hands well and often.

For the first couple of months after surgery, youll see the doctor often to make sure the new kidney is working well. If your child gets a fever or soreness in the area of the transplant, tell a doctor right away. These could be signs that the body isnt accepting the new kidney or that your child has an infection.

The Gut Microbiome Is Structurally Altered By Immunosuppressants

What is Kidney Disease? | The Kidney Disease, Heart Disease, and Diabetes Connection | NKF

The large intestine is the most heavily colonized site in the body where microbial cell density exceeds all other human microbiome sites by at least two orders of magnitude . The gut microbiome has a profound influence on host metabolism and immunity , and its composition remains relatively stable in healthy adults . Following transplantation, however, significant changes to structure have been reported .

In solid organ transplantation, the immunosuppressants ciclosporin and tacrolimus have been well documented to result in significant structural changes to the gut microbiome. A large liver transplantation study reported that recipients, largely administered with ciclosporin or tacrolimus , had decreased Bifidobacterium spp., Lactobacillus spp. and Faecalibacterum prausnitzii, and significantly higher Enterobacteriaceae and Enterococcus spp. . Although gut microbiomes are individualized key compositional changes including lower overall diversity and increases in the relative abundance of Proteobacteria have been reported post-transplantation. Whether fecal microbiota transplantation could restore the microbiome post-transplant, an effective treatment for Clostridium difficile infection, remains to be studied at scale .

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What Is A Valuable Type Of Probiotics

At present, there are many different types of microbiological bacteria each one has the separate effects. To determine the impact of microbial strains, treatment and clinical examination practically are necessary. Great probiotics need to meet the following criteria:

Firstly, the effectiveness of probiotics depends on the type of bacteria inside them. Bacterial strains that were selected and developed from useful microorganisms in the human body have been studied and tested clinically. Some bacterial groups were recommended by World Health Organization to use like yeast strains of the Saccharomycetaceae, Lactobacillus, Bacillus.

A study sponsored by Nation Center for Complementary and Integrative Health revealed that Lactobacillus strains were safe for over 65-year-old healthy inhabitants.

Secondly, the content of bacterial strain must have a minimum of 107 CFU/gr. According to WHO, to get the most efficient effects, the bacterial content must reach from 107 to 1010 CFU/gr. If the microbiological level is out of this range, their ability to survive and grow in the digestive tract will not be high, leading to lower their effects and even be ineffective.

Clinical Manifestations Of Microbiome Disruption

Differences in microbiota after transplantation can be associated with clinically significant events. Decreased Firmicutes in small bowel recipients has been associated with acute rejection . In lung transplant patients, restoration of microbiota diversity decreased the risk of bronchiolitis obliterans syndrome . Bronchial samples containing greater than 10% Pseudomonas aeruginosa were associated with symptomatic infection, while those containing greater than 10% P.fluorescens were not. No sample had greater than 10% of both species . Such changes, however, are difficult to interpret in the presence of concomitant antimicrobial administration.

Fricke et al. demonstrated that major shifts in microbiota composition were identifiable at one month after renal transplant . In another study of 26 renal transplant recipients, Lee at al. identified increased Proteobacteria species in rectal microbiota at 90 days . Patients with post-transplant diarrhea had reduced microbiota diversity, with reduced Bacteroides, Ruminococcus, Coprococcus, and Dorea. Patients with abundant Enterococcus in rectal stool samples were more likely to have an Enterococcus urinary tract infection .

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Does It Matter Which Probiotic I Use

Multiple probiotics have been studied with a specific focus on kidney disease. Bacillus pasteurii, Sporlac, Lactobacillus acidophilus, Escherichia coli-DH5, and others . There are many researchers in a variety of universities that study probiotics and prebiotics with kidney disease. Kibow Biotech, who produces Renadyl, is the only company that specifically studied probiotics for kidneys. Their probiotic consists of (S thermophilus-KB19, L acidophilus-KB27, and B longum-KB3 in a dosage of about 90 billion organisms. Dr. Ranganathan, the founder of Kibow Biotech, and one of the primary researchers has been studying this formula for 20+ years.

Current studies with Renadyl show that especially in later stages of CKD that uremic toxins were able to be broken down and excreted with help of their probiotic strains. Plus, remember I just mentioned bacterial production of ammonia and ammonium hydroxide from breaking down uremic toxins? There is some interesting data that Renadyl can help reduce that as well . Each of the different strains of bacteria has been chosen for a specific purpose. For example, per their report S. thermophils-KB19 breaks down urea, uric acid and creatinine, while B. longum-KB31 helps reduce levels of protein bound uremic toxins like p-cresol and indoles .

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How L Reuteri Reduces Cholesterol Levels

Could Your Probiotic Be Making You Sicker?

The key to success for L. reuteri is in its ability to produce an enzyme called bile salt hydrolase. This enzyme makescholesterol less absorbable so that instead of being absorbed into the bloodstream, it becomes trapped in the gut, then later excreted in fecal matter.21

Like all fats, cholesterol in its free state cannot dissolve in water and is not easily absorbed on its own. This creates a problem because cholesterolboth LDL and HDLis beneficial for the body and is necessary for functions such as forming cell membranes and creating hormones.

In order to make cholesterol more absorbable, liver cells produce free bile acids, which are then bonded to the amino acids glycine and taurine and secreted into the intestines.22 Conjugated bile acids are more water-soluble than free bile acids, meaning they are better able to assist with the absorption of cholesterol.15

The problem is that when too much cholesterol is available, either from excess dietary consumption or excess release from the liver into the small intestine, the reabsorption of cholesterol causes the body to maintain blood cholesterol levels higher than necessary, raising cardiovascular disease risk.23-27

Other Lactobacillus Research

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Evaluation After Having Covid

You can still receive an evaluation after having COVID-19, but your healthcare team will need to tell you when you will be free from infection. Also, depending on your current health status and the impact of COVID-19 on hospital staff and supplies, your transplant may be delayed or postponed. You should discuss this with your transplant center.

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How Probiotics Support A Healthy Heart

More than 2000 years ago, Hippocrates said all disease begins in the gut. But only now are we beginning to understand how the gastrointestinal system mediates many functions and is therefore central to health and disease. Apart from the ever-increasing incidence of digestive disorders, an unhealthy gut and an imbalance in gut bacteria can contribute to a wide range of diseases, including heart disease.

How are our gut bacteria relevant to heart health? People with reduced microbial diversity in the gut are at a higher risk of cardiovascular disease . A recent study showed that heart failure patients who eat more fibre have healthier balance of gut bacteria, which has been linked to reduced risk of death and need for a heart transplant.

So its clear that one of the most natural ways to support heart health includes optimising our gut bacteria through diet and using the right probiotics that have been researched for their heart health-promoting properties.

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Practical Applications For Probiotics

While these findings show exciting promise, probiotic therapy may not be necessary for all patients. Understanding which patients might benefit and what type of probiotics to use takes a lot of careful research and trial and error.

Lets start by examining why probiotics may be helpful and when to use caution.

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Antibiotics Probiotics And Prebiotics

What You Should and Shouldnt Eat or Drink After Your Kidney Transplant

To prevent or treat complications and ameliorate the imbalanced gut microbiota after allogeneic transplantation, gut microbial intervention methods are used. Antibiotics, probiotics and prebiotics are most often used. Promising and encouraging results have been obtained . However, the role of intestinal decontamination in allogeneic transplantation is still controversial.

Table 2 The results of different gut microbial intervention methods

Probiotic administration is also useful in ameliorating gut microbial dysbiosis after SBT. Compared with non-treated hosts, small bowel histological injuries were significantly ameliorated and BT was reduced in rats with 6 days of probiotics treatment after SBT . Similarly, in mice with an allogeneic stem cell transplantation, modifying the intestinal microbiota using the probiotic microorganism Lactobacillus rhamnosus resulted in a reduced translocation of enteric bacteria to the mesenteric lymph nodes, reduced acute GVHD and improved survival .

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Who Can Have A Kidney Transplant

Most people who need a kidney transplant are able to have one, regardless of their age, as long as:

  • theyre well enough to withstand the effects of surgery
  • the transplant has a relatively good chance of success
  • the person is willing to comply with the recommended treatments required after the transplant such as taking immunosuppressant medication and attending regular follow-up appointments

Reasons why it may not be safe or effective to perform a transplant include having an ongoing infection , severe heart disease, cancer that has spread to several places in your body, or AIDS.

Dysbiosis And Renal Fibrosis

In a recent study on transplant patients, Modena et al.42 collected urinary samples from 25 patients after kidney transplantation. All of these patients developed interstitial fibrosis/tubular atrophy at 6 months after transplantation at kidney biopsy. Patients were compared with 23 kidney transplant recipients who did not develop IF/TA. Patients with IF/TA had a decreased number of Lactobacillus and Streptococcus genera. The authors concluded that modification of the urinary microbiota could develop IF/TA by altering the host immune response.

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Mechanisms Of Microbiota Stimulation Of The Enteric Immune System

The microbiota interacts with the intestinal epithelial cells and resident immune cells to activate both innate and adaptive mechanisms . Microbial products are sensed by receptors of the IEC, such as toll-like receptor and nucleotide-binding oligomerization domain . For example, peptidoglycan from gram negative bacteria binds NOD1 and elicits production of CCL20 and β-defensin-3 to recruit B cells to the lamina propria and induce expression of IgA . Development of intestinal lymphoid follicles depends on the presence of both microbial products and lymphoid tissue inducer cells , a subset of innate lymphoid cells , in the LP . At homeostasis, bacterial products stimulate production of mucus, bactericidal molecules, and biofilms by IEC to exclude pathogenic bacteria and promote colonization by commensal bacteria . Virulence factors may penetrate the mucus and activate innate effectors in the LP such as natural killer T cells and ILC. In response to IEC-derived pro-inflammatory cytokines, ILC release IL-22 to help maintain the integrity of the epithelium and produce antimicrobial peptides . In contrast, commensal bacteria provide tonic stimulation of the apical receptors to dampen the inflammatory response by various adaptive mechanisms. For example, Bacteroides and Lactobacillus species inhibit activation of the classical NF-κB pathway and its downstream pro-inflammatory genes .

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