European consensus conference on faecal microbiota transplantation in clinical practice

Abstract

Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements.

Recruitment of feces donors among blood donors: Results from an observational cohort study

“…8 First, a screening program that minimizes the risk of transferring infectious and non-infectious diseases must be implemented. Detailed screening protocols have been published, 7 , 9-11 but the work required for their implementation is extensive; moreover, despite a scientific consensus for this vigorous screening, 12 , 13 the evidence supporting the screening protocols remains low. Second, as FMT gains momentum, an inherent need for recruiting enough potential feces donors evolves.…”

Prevention and treatment of Clostridium difficile infection

“…11 In accordance, FMT is recommended as a treatment option for both mild and severe RCDI with high quality of grading and strong recommendation as evidence is available from several RCTs. Furthermore, FMT can be considered also in refractory CDI, however, in this case the quality of evidence is low and further study are awaited to give more robust results on this matter.…”

Dysbiosis in Functional Bowel Disorders

“…infections; this has been confirmed in many studies and a number of meta-analyses [76]. For details of the technical aspects of FMT, the reader is referred to respective papers [77, 78]; meanwhile, ethical standards have been discussed [79] and procedural standards have been set by respective organizations, for example, for European gastroenterologists [80], in ­Canada [81] and in Australia [82]. …”