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Am J Transplant. 2019 Feb;19(2):501-511. doi: 10.1111/ajt.15058. Epub 2018 Aug 31.

Fecal microbiota transplantation for the treatment of recurrent and severe Clostridium difficile infection in solid organ transplant recipients: A multicenter experience.

Author information

1
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
2
Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
3
Department of Biostatistics, The Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, IN, USA.
4
Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
5
Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA.
6
Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, GA, USA.
7
Department of Pathology, Emory University, Atlanta, GA, USA.
8
Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
9
Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
10
Division of Gastroenterology, Department of Medicine, Henry Ford Medical Center, Detroit, MI, USA.
11
Division of Gastroenterology, Department of Medicine, Temple University, Philadelphia, PA, USA.
12
Division of Infectious Diseases, Department of Medicine, University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA.
13
William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
14
Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
15
Division of Gastroenterology, Department of Medicine, University of Utah, Salt Lake City, UT, USA.
16
OpenBiome, Somerville, MA, USA.
17
Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.

Abstract

Fecal microbiota transplant (FMT) is recommended for Clostridium difficile infection (CDI) treatment; however, use in solid organ transplantation (SOT) patients has theoretical safety concerns. This multicenter, retrospective study evaluated FMT safety, effectiveness, and risk factors for failure in SOT patients. Primary cure and overall cure were defined as resolution of diarrhea or negative C difficile stool test after a single FMT or after subsequent FMT(s) ± anti-CDI antibiotics, respectively. Ninety-four SOT patients underwent FMT, 78% for recurrent CDI and 22% for severe or fulminant CDI. FMT-related adverse events (AE) occurred in 22.3% of cases, mainly comprising self-limiting conditions including nausea, abdominal pain, and FMT-related diarrhea. Severe AEs occurred in 3.2% of cases, with no FMT-related bacteremia. After FMT, 25% of patients with underlying inflammatory bowel disease had worsening disease activity, while 14% of cytomegalovirus-seropositive patients had reactivation. At 3 months, primary cure was 58.7%, while overall cure was 91.3%. Predictors of failing a single FMT included inpatient status, severe and fulminant CDI, presence of pseudomembranous colitis, and use of non-CDI antibiotics at the time of FMT. These data suggest FMT is safe in SOT patients. However, repeated FMT(s) or additional antibiotics may be needed to optimize rates of cure with FMT.

KEYWORDS:

clinical research/practice; complication: infectious; immunosuppression/immune modulation; infection and infectious agents - bacterial: Clostridium difficile; infectious disease; intestinal disease: infectious; organ transplantation in general; patient safety

PMID:
30085388
PMCID:
PMC6349556
[Available on 2020-02-01]
DOI:
10.1111/ajt.15058

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