The Microbiome and Pediatric Transplantation

The Microbiome and Pediatric Transplantation

Caitlin W. Elgarten, 1,2,†, Elisa B. Margolis, 3,4,†, and Matthew S. Kelly5,
1Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA, 2Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania,
USA, 3Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA, 4Department of Pediatrics, University of Tennessee Health Sciences
Center, Memphis, Tennessee, USA, and 5Departments of Pediatrics and Molecular Genetics & Microbiology, Duke University School of Medicine, Durham, North Carolina, USA
The microbial communities that inhabit our bodies have been increasingly linked to host physiology and pathophysiology. This
microbiome, through its role in colonization resistance, influences the risk of infections after transplantation, including those caused
by multidrug-resistant organisms. In addition, through both direct interactions with the host immune system and via the production
of metabolites that impact local and systemic immunity, the microbiome plays an important role in the establishment of immune
tolerance after transplantation, and conversely, in the development of graft-versus-host disease and graft rejection. This review offers
a comprehensive overview of the evidence for the role of the microbiome in hematopoietic cell and solid organ transplant complications,
drivers of microbiome shift during transplantation, and the potential of microbiome-based therapies to improve pediatric
transplantation outcomes.
Key words. antibiotic resistance; biotherapeutics; gut microbiota; hematopoietic stem cell transplant; solid organ transplant.