TY - JOUR
T1 - Fecal Microbiota Transplantation Is Safe and Effective in Patients With Clostridioides difficile Infection and Cirrhosis
AU - Cheng, Yao Wen
AU - Alhaffar, Dana
AU - Saha, Srishti
AU - Khanna, Sahil
AU - Bohm, Matthew
AU - Phelps, Emmalee
AU - Ghabril, Marwan
AU - Orman, Eric
AU - Sashidhar, Sagi
AU - Rogers, Nicholas
AU - Xu, Huiping
AU - Khoruts, Alexander
AU - Vaughn, Byron
AU - Kao, Dina
AU - Wong, Karen
AU - Cammarota, Giovanni
AU - Ianiro, Gianluca
AU - Dhere, Tanvi
AU - Kraft, Colleen S.
AU - Mehta, Nirja
AU - Woodworth, Michael H.
AU - Allegretti, Jessica R.
AU - Nativ, Lotem
AU - Marcus, Jenna
AU - El-Nachef, Najwa
AU - Fischer, Monika
N1 - Funding Information:
Funding Supported by Alberta Health Services and University of Alberta Hospital Foundation (D.K. and K.W.). Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under award number K23AI144036 (M.H.W.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2021 AGA Institute
PY - 2021/8
Y1 - 2021/8
N2 - 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 the 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 the 8-week follow-up evaluation. We also obtained data on adverse events (AEs) and severe AEs within 12 weeks of FMT. Results: Patients underwent FMT for recurrent CDI (55 of 63; 87.3%), severe CDI (6 of 63; 9.5%), or fulminant CDI (2 of 63; 3.2%) primarily via colonoscopy (59 of 63; 93.7%) as outpatients (47 of 63; 76.8%). FMT success was achieved for 54 patients (85.7%). Among FMT failures, a higher proportion used non-CDI antibiotics at the 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 the 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 a greater risk of FMT failure. FMT-related AEs occurred in 33.3% of patients (21 of 63)—most were self-limited abdominal cramps or diarrhea. There were only 5 severe AEs that possibly were related to FMT; none involved infection or death. Conclusions: In a retrospective study, we found FMT to be safe and effective for the treatment of CDI in patients with cirrhosis.
AB - 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 the 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 the 8-week follow-up evaluation. We also obtained data on adverse events (AEs) and severe AEs within 12 weeks of FMT. Results: Patients underwent FMT for recurrent CDI (55 of 63; 87.3%), severe CDI (6 of 63; 9.5%), or fulminant CDI (2 of 63; 3.2%) primarily via colonoscopy (59 of 63; 93.7%) as outpatients (47 of 63; 76.8%). FMT success was achieved for 54 patients (85.7%). Among FMT failures, a higher proportion used non-CDI antibiotics at the 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 the 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 a greater risk of FMT failure. FMT-related AEs occurred in 33.3% of patients (21 of 63)—most were self-limited abdominal cramps or diarrhea. There were only 5 severe AEs that possibly were related to FMT; none involved infection or death. Conclusions: In a retrospective study, we found FMT to be safe and effective for the treatment of CDI in patients with cirrhosis.
KW - Bacterial Infection
KW - Infectious Diarrhea
KW - Intestinal Microbiota
KW - MELD
UR - http://www.scopus.com/inward/record.url?scp=85108256363&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85108256363&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2020.06.051
DO - 10.1016/j.cgh.2020.06.051
M3 - Article
C2 - 32645451
AN - SCOPUS:85108256363
SN - 1542-3565
VL - 19
SP - 1627
EP - 1634
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 8
ER -