The impact of gastrointestinal dysmotility on the aerodigestive microbiome of pediatric lung transplant recipients.

• BACKGROUND:Delayed gastric emptying has been associated with increased graft rejection, althoughthe mechanism of this association is not known. This study aims to investigate the interrelationshipbetween delays in gastrointestinal motility and the diversity and composition of gastric, oropharyngeal,and lung microbiomes in pediatric lung transplant recipients.METHODS:We prospectively recruited 23 pediatric lung transplant recipients and 98 pediatric patientswith respiratory symptoms undergoing combined endoscopy and bronchoscopy. Gastric, oropharyn-geal, and bronchoalveolar lavage samples were collected for 16S sequencing. Gastric samples werealso analyzed for bile composition using liquid chromatography.RESULTS:Patients who underwent lung transplantation had significantly reduced alpha diversity in gas-tric and oropharyngeal sites compared with patients with respiratory symptoms. This reduction in alphadiversity was especially evident in gastric samples in patients with delayed gastric emptying defined asabnormal gastric emptying on nuclear scintigraphy or as an elevation in gastric bile concentration (p≤0.05). Whereas monocolonies were seen in the lungs of patients who underwent transplantation, thesewere not the same microbes seen in the stomach; the microbial overlap between lung and gastric sam-ples within patients was low, and data indicated high individual variation between lung transplantrecipients. Other contributors to reduced alpha diversity included antibiotics in combination with pro-ton pump inhibitors, especially in gastric and oropharyngeal samples.CONCLUSIONS:Lung transplant recipients have reduced microbial diversity in gastric fluid (GF) andoropharynx compared with patients who did not undergo lung transplantation. The decreased alphadiversity in GF may be associated with dysmotility.J Heart Lung Transplant 000;000:1−10ÓPublished by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation.

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MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

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