The role of the gut microbiome in solid organ transplantation

Despite ground-breaking advances in allogeneic transplantation, allograft rejection and immunosuppressant-specific complications remain a major challenge. Growing evidence suggests the human gut microbiome to be a potential contributor to transplantation outcome and patient health. After breakthrough findings in hematopoietic stem cell transplantation (HSCT), the relevance of the microbiome in solid organ transplantation (SOT) is becoming increasingly clearer. This article reviews the role of the microbiome in SOT focusing on its significance for transplantation-associated complications, such as allograft rejection and highlights its potential impact on immunosuppressive treatment. Moreover, the emerging role of the microbiome as a diagnostic biomarker and therapeutic target is elucidated and current microbial intervention strategies are discussed. The gut microbiome harbors countless possibilities for clinical applications and holds great promise of having a lasting impact on transplantation medicine.