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

Yao-Wen Cheng, Emmalee Phelps, Vincent Ganapini, Noor Khan, Fangqian Ouyang, Huiping Xu, Sahil Khanna, Raseen Tariq, Rachel J Friedman-Moraco, Michael H Woodworth, Tanvi Dhere, Colleen S Kraft, Dina Kao, Justin Smith, Lien Le, Najwa El-Nachef, Nirmal Kaur, Sree Kowsika, Adam Ehrlich, Michael Smith, Nasia Safdar, Elizabeth Ann Misch, Jessica R Allegretti, Ann Flynn, Zain Kassam, Asif Sharfuddin, Raj Vuppalanchi, Monika Fischer
American Journal of Transplantation 2019, 19 (2): 501-511
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.

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