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

Research paper by Yao-Wen YW Cheng, Emmalee E Phelps, Vincent V Ganapini, Noor N Khan, Fangqian F Ouyang, Huiping H Xu, Sahil S Khanna, Raseen R Tariq, Rachel J RJ Friedman-Moraco, Michael H MH Woodworth, Tanvi T Dhere, Colleen S CS Kraftc, Dina D Kao, Justin J Smith, Lien L Le, et al.

Indexed on: 08 Aug '18Published on: 08 Aug '18Published in: American Journal of Transplantation



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. 94 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 comprised of 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 IBD had worsening disease activity, while 14% of CMV 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. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.