Fecal Microbiota Transplantation is Safe and Effective in Patients with Clostridioides difficile Infection and Cirrhosis

Yao-Wen Cheng, Dana Alhaffar, Srishti Saha, Sahil Khanna, Matthew Bohm, Emmalee Phelps, Marwan Ghabril, Eric Orman, Sagi Sashidhar, Nicholas Rogers, Huiping Xu, Alexander Khoruts, Byron Vaughn, Dina Kao, Karen Wong, Giovanni Cammarota, Gianluca Ianiro, Tanvi Dhere, Colleen S Kraft, Nirja Mehta, H Michael Woodworth, Jessica R Allegretti, Lotem Nativ, Jenna Marcus, Najwa El-Nachef, Monika Fischer
Clinical Gastroenterology and Hepatology 2020 July 6

BACKGROUND & AIMS: Clostridioides difficile infection (CDI) harms a large proportion of patients with cirrhosis. Fecal microbiota transplantation (FMT) is recommended for recurrent CDI, but its effects in patients with cirrhosis have not been established. We performed a multicenter, observational study to evaluate efficacy and safety of FMT for CDI in patients with cirrhosis.

METHODS: We performed a retrospective study of 63 adults with cirrhosis (median model for end-stage liver disease score, 14.5; 24 patients with decompensated cirrhosis) who underwent FMT for CDI from January 2012 through November 2018 at 8 academic centers in the United States, Canada, and Italy. We collected data on patient demographics and characteristics of cirrhosis, CDI, and FMT from medical records and compared differences among patients with different severities of cirrhosis, and FMT successes vs failures at 8 weeks follow up. We also obtained data on adverse events (AE) and severe AEs (SAE) within 12 weeks of FMT.

RESULTS: Patients underwent FMT for recurrent CDI (55/63; 87.3%), severe CDI (6/63; 9.5%), or fulminant CDI (2/63; 3.2%) primarily via colonoscopy (59/63; 93.7%) as outpatients (47/63; 76.8%). FMT success was achieved for 54 patients (85.7%). Among FMT failures, a higher proportion used non-CDI antibiotics at time of FMT (44.4% vs 5.6%; P<.001), had Child-Pugh scores of B or C (100% vs 37.7%; P<.001), used probiotics (77.8% vs 24.1%, P=.003), had pseudomembranes (22.2% vs 0; P=.018), and underwent FMT as inpatients (45.5% vs 19%; P=.039), compared with FMT successes. In multivariable analysis, use of non-CDI antibiotics at time of FMT (odds ratio, 17.43; 95% CI, 2.00-152.03; P=.01) and use of probiotics (odds ratio, 11.9; 95% CI, 1.81-78.3; P=.01) were associated with greater risk of FMT failure. FMT-related AEs occurred in 33.3% of patients (21/63)-most were self-limited abdominal cramps or diarrhea. There were only 5 SAEs that were possibly related to FMT; none involved infection or death.

CONCLUSIONS: In a retrospective study, we found FMT to be safe and effective for treatment of CDI in patients with cirrhosis.

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