Prebiotic Supplementation in Kidney Transplant Recipients for Preventing Infections and Gastrointestinal Upset: A Randomized Controlled Feasibility Study

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Chan, S
Hawley, CM
Pascoe, EM
Cao, C
Campbell, SB
Campbell, KL
Francis, RS
Hale, R
Isbel, NM
Morrison, M
Johnson, DW
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Objectives: Modulating the large intestinal microbiome of kidney transplant recipients (KTRs) may reduce infectious complications. The aim of this study is to assess the feasibility of a randomized controlled trial of prebiotics in reducing infections and gastrointestinal symptoms in KTRs. (Design) and Methods: Acute KTRs were recruited to a double-blind, placebo-controlled, randomized trial at a single kidney transplant center. Patients were provided with prebiotics or placebo for 7 weeks. The primary outcome was feasibility, defined as recruitment of ≥80% of eligible people within 6 months. Secondary outcomes included adherence and tolerability, participant retention in trial, proportions of participants providing serum and stool specimens, self-reported quality of life, gastrointestinal symptoms, and infection events. Results: During the 7-week period, 72 patients met eligibility criteria, of whom 60 (83%) consented to participate (mean ± standard deviation age 53 ± 12 years; 62% males). Fifty-six (78%) participants were randomized (27 interventions and 29 controls). Although participants receiving intervention experienced reduced gastrointestinal symptoms (−0.28 [interquartile range, IQR −0.67 to 0.08] vs. −0.07 [IQR −0.27 to 0], P = .03), both control and intervention groups were similar in adherence (67% vs. 72%, P = .36), tolerability (56% vs. 62%, P = .64), quality of life (−0.2 [IQR −0.6 to 0] vs. −0.2 [IQR −0.8 to 0], P = .82), and infection events (33% vs. 34%, P = .83). Blood and stool samples were collected from ≥90% of participants in both groups. Conclusions: It is feasible to recruit and retain acute KTRs in a randomized, placebo-controlled trial examining the effect of prebiotics on infections and gastrointestinal symptoms. This study also showed that prebiotics significantly reduced gastrointestinal symptoms.

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Journal of Renal Nutrition

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© 2022 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY license (

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Clinical sciences

Nutrition and dietetics

Feasibility Study

Gastrointestinal Intolerance

Gastrointestinal Microbiota


Kidney Transplantation

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Chan, S; Hawley, CM; Pascoe, EM; Cao, C; Campbell, SB; Campbell, KL; Francis, RS; Hale, R; Isbel, NM; Morrison, M; Johnson, DW, Prebiotic Supplementation in Kidney Transplant Recipients for Preventing Infections and Gastrointestinal Upset: A Randomized Controlled Feasibility Study, Journal of Renal Nutrition, 2022