title: Longitudinal Analysis of the Intestinal Microbiota in Liver Transplantation.
abstract: BACKGROUND
  Increasing evidence suggests that the intestinal microbiota plays an important role in liver diseases. However, the dynamics of the intestinal microbiota during liver transplantation (LT) and its potential role in clinical course remain unknown.
  
  
  METHODS
  We prospectively analyzed the intestinal microbiota of 38 patients who underwent LT in Kyoto University Hospital. We characterized the microbial compositions of fecal specimens from LT patients using a metagenomics approach by an Illumina MiSeq platform. We analyzed the diversity of microbiota sequentially from pretransplantation until 2 months after LT and also compared the microbiota during an episode of acute cellular rejection (ACR) and bloodstream infections (BSI) to the microbial composition of time-matched fecal specimens obtained from patients who did not experience ACR or BSI, respectively.
  
  
  RESULTS
  Three hundred twenty fecal specimens were analyzed. Dynamic changes were observed in the microbial composition of LT recipients during the perioperative period. Over the course of LT, the mean diversity index decreased during the first 3 weeks after LT and gradually increased during our observation period. The loss of intestinal microbiota diversity was associated with high Child-Pugh scores, high model for end-stage liver disease scores, ACR, and BSI. At the family level,Bacteroides,Enterobacteriaceae,Streptococcaceae,andBifidobacteriaceaewere increased whereasEnterococcaceae,Lactobacillaceae,Clostridiaceae,Ruminococcaceae,andPeptostreptococcaceaewere decreased in ACR patients.
  
  
  CONCLUSIONS
  The microbiota of LT patients was associated with the severity of liver diseases and the presence of ACR and BSI. These results lay the groundwork for more comprehensive investigations of microbiota characteristics to identify diagnostic markers for transplant health and to guide intervention strategies to improve transplant outcomes.
authors.affiliation: Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Karin
authors.initials: K
authors.lastname: Kato
authors.affiliation: Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Nagao
authors.affiliation: Tokyo R&D Center, Miyarisan Pharmaceutical. Co., Ltd., Wako, Saitama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Miyamoto
authors.affiliation: Tokyo R&D Center, Miyarisan Pharmaceutical. Co., Ltd., Wako, Saitama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Oka
authors.affiliation: Tokyo R&D Center, Miyarisan Pharmaceutical. Co., Ltd., Wako, Saitama, Japan.
authors.forename: Motomichi
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Matsumura
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Toshimi
authors.initials: T
authors.lastname: Kaido
authors.affiliation: Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.affiliation: Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ichiyama