Colonizing multidrug-resistant bacteria and the longitudinal evolution of the intestinal microbiome after liver transplantation

Medini K. Annavajhala, Angela Gomez-Simmonds, Nenad Macesic, Sean B. Sullivan, Anna Kress, Sabrina D. Khan, Marla J. Giddins, Stephania Stump, Grace I. Kim, Ryan Narain, Elizabeth C. Verna and Anne-Catrin Uhlemann ()
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Medini K. Annavajhala: Columbia University Irving Medical Center
Angela Gomez-Simmonds: Columbia University Irving Medical Center
Nenad Macesic: Columbia University Irving Medical Center
Sean B. Sullivan: Columbia University Irving Medical Center
Anna Kress: Columbia University Irving Medical Center
Sabrina D. Khan: Columbia University Irving Medical Center
Marla J. Giddins: Columbia University Irving Medical Center
Stephania Stump: Columbia University Irving Medical Center
Grace I. Kim: Columbia University Irving Medical Center, NY Presbyterian Hospital
Ryan Narain: Columbia University Irving Medical Center, NY Presbyterian Hospital
Elizabeth C. Verna: Columbia University Irving Medical Center, NY Presbyterian Hospital
Anne-Catrin Uhlemann: Columbia University Irving Medical Center

Nature Communications, 2019, vol. 10, issue 1, 1-12

Abstract: Abstract Infections by multidrug-resistant bacteria (MDRB) remain a leading cause of morbidity and mortality after liver transplantation (LT). Gut dysbiosis characteristic of end-stage liver disease may predispose patients to intestinal MDRB colonization and infection, in turn exacerbating dysbiosis. However, relationships between MDRB colonization and dysbiosis after LT remain unclear. We prospectively recruited 177 adult patients undergoing LT at a single tertiary care center. 16 S V3-V4 rRNA sequencing was performed on 723 fecal samples collected pre-LT and periodically until one-year post-LT to test whether MDRB colonization was associated with decreased microbiome diversity. In multivariate linear mixed-effect models, MDRB colonization predicts reduced Shannon α-diversity, after controlling for underlying liver disease, antibiotic exposures, and clinical complications. Importantly, pre-LT microbial markers predict subsequent colonization by MDRB. Our results suggest MDRB colonization as a major, previously unrecognized, marker of persistent dysbiosis. Therapeutic approaches accounting for microbial and clinical factors are needed to address post-transplant microbiome health.

Date: 2019
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DOI: 10.1038/s41467-019-12633-4

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