Probiotic use in pediatric kidney transplant recipients: What are current practices, and are they evidence‐based? A pediatric nephrology research consortium study

Background Probiotics are living microorganisms that may confer health benefits to their host if administered in sufficient quantities. However, data on the use of probiotics in transplant recipients are scarce. Method This multi‐center survey of pediatric nephrologists aimed to examine variations in practice regarding the use of probiotics in pediatric kidney transplant recipients. The survey was conducted via a 10‐item questionnaire (developed in Survey Monkey) administered to pediatric nephrologists participating in the Pediatric Nephrology Research Consortium meeting in April 2023. Results Sixty‐four pediatric nephrologists completed the survey. Twenty‐seven (42.2%) respondents reported having prescribed probiotics to pediatric kidney transplant recipients. The primary reason for probiotic use was the treatment of antibiotic‐associated diarrhea (n = 20), with other reasons including recurrent Clostridium difficile infection (n = 15), general gut health promotion (n = 12), recurrent urinary tract infections (n = 8), and parental request (n = 1). Of those who prescribed probiotics, 48.1% held them during periods of neutropenia and 14.8% during central venous line use. Of the 64 respondents, 20 reported the lack of safety data as a concern for using probiotics in kidney transplant recipients. Conclusion Pediatric nephrologists are increasingly prescribing probiotics to pediatric kidney transplant recipients; nevertheless, substantial practice variations exist. The paucity of safety data is a significant deterrent to probiotic use in this population. This multi‐center survey of 64 pediatric nephrologists shows that probiotics are being increasingly prescribed to pediatric kidney transplant recipients for various indications, including antibiotic‐associated diarrhea, Clostridium difficile infection, and recurrent urinary tract infections. However, significant variations in practice exist, with a lack of safety data being the main deterrent.