Dietary Inulin for Gut Health in Solid-organ Transplantation (DIGEST)

None listed

Protocol: Kidney transplant recipients will be screened and enrolled at week 3 following transplantation. Participants will be randomised (1:1) to receive at 4 weeks post-transplant either inulin (intervention) or continue with standard care. Subjects randomised to receive inulin will be asked to drink 10g of inulin dissolved in 200ml water once daily for one week, and then twice daily for a further 3 weeks. Subjects randomised to standard care will be instructed to consume the same quantity of water, without additional supplementation. Compliance with fibre supplementation will be assessed by powder weight every 7 days. All participants will receive standard post-transplant care including immunosuppression and medication use will be recorded throughout the study. Participants will be asked to keep a 4-day food diary prior to and during the final 4 days of supplementation, to be analysed using Foodwerx. Subjects will undergo continuous glucose monitoring for 2 periods of 14 days, from week 3 and week 7 post-transplant, to measure insulin resistance (HOMA) and glycaemic control (mean glucose, time in diabetic range, GRADE and MAGE scores). Kidney function (eGFR, albuminuria) and allograft response (kidney biopsy and test for donor-specific antibodies) will be assessed at month 3 and at any time of graft dysfunction. Patients will provide blood and faecal samples for analysis of SCFA (serum and stool, by NMR spectroscopy) and microbiota/metagenome (stool, by 16s rRNA sequencing) at (1) pre-supplement; (2) last week of supplementation; (3) at month 3 post-transplant. Gut homeostasis (blood Zonulin, LPS, CRP, IL-6, IL-17) and symptoms (Gastrointestinal Ratings Scale), cardiovascular risk profile (lipids, blood pressure, weight, CVD events), infections and hospitalisations will be recorded.