Division of Gastroenterology & Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.
GI and Liver Innate Immune Program, University of Colorado School of Medicine, Aurora, CO.
Transplantation. 2019 Apr;103(4):668-678. doi: 10.1097/TP.0000000000002568.
Gut dysbiosis, defined as a maladaptive gut microbial imbalance, has been demonstrated in patients with end-stage liver disease, defined as a contributor to disease progression, and associated clinically with severity of disease and liver-related morbidity and mortality. Despite this well-recognized phenomena in patients with end-stage liver disease, the impact of gut dysbiosis and its rate of recovery following liver transplantation (LT) remains incompletely understood. The mechanisms by which alterations in the gut microbiota impact allograft metabolism and immunity, both directly and indirectly, are multifactorial and reflect the complexity of the gut-liver axis. Importantly, while research has largely focused on quantitative and qualitative changes in gut microbial composition, changes in microbial functionality (in the presence or absence of compositional changes) are of critical importance. Therefore, to translate functional microbiomics into clinical practice, one must understand not only the compositional but also the functional changes associated with gut dysbiosis and its resolution post-LT. In this review, we will summarize critical advances in functional microbiomics in LT recipients as they apply to immune-mediated allograft injury, posttransplant complications, and disease recurrence, while highlighting potential areas for microbial-based therapeutics in LT recipients.
肠道菌群失调，定义为肠道微生物失衡失调，在终末期肝病患者中已有研究表明，其可导致疾病进展，并与疾病严重程度及与肝脏相关的发病率和死亡率相关联。尽管终末期肝病患者中存在这一公认的现象，但肠道菌群失调及其在肝移植（LT）后恢复的情况仍不完全清楚。肠道微生物群的改变如何直接和间接影响移植物代谢和免疫的机制是多因素的，反映了肠道-肝脏轴的复杂性。重要的是，尽管研究主要集中在肠道微生物组成的定量和定性变化上，但微生物功能的变化（存在或不存在组成变化）是至关重要的。因此，为了将功能微生物组学转化为临床实践，人们必须不仅了解与肠道菌群失调及其在 LT 后解决相关的组成变化，还要了解功能变化。在这篇综述中，我们将总结 LT 受者功能微生物组学的重要进展，这些进展适用于免疫介导的移植物损伤、移植后并发症和疾病复发，并强调 LT 受者基于微生物的治疗的潜在领域。
