Fecal Microbiota Transplantation for Clostridioides Difficile Infection in Patients with Chronic Liver Disease

Abstract

Background. Fecal microbiota transplantation (FMT) is a well-established therapeutic option for patients with antibiotic resistant Clostridioides difficile infection (CDI). However, the efficacy of FMT in patients with chronic liver disease remains elusive. Aims. We studied the effect of FMT on chronic liver disease (CLD) patients with CDI at our tertiary medical center. Methods. A cohort of all patients who received FMT from December 2012 to May 2014 for refractory or recurrent CDI was identified. Patients were monitored for a year after FMT. Descriptive analysis was conducted to compare the effect of FMT in patients with and without CLD. Results. A total of 201 patients with CDI received FMT, 14 of which had a history of CLD. Nine of these patients exhibited cirrhosis of the liver with a mean Child-Turcotte-Pugh score of 8. CDI development in these patients was associated with recent exposure to antibiotics and was observed to be significantly different between both groups (17% of CLD patients vs. 58% in the general cohort, p=0.01). Four patients with CLD received >1 FMT, of which 2 did not respond to treatment. There was no significant difference between patients with liver disease and the rest of the cohort with regard to FMT response (12/14 (87%) vs. 164/187 (88%), p=0.68). Conclusion. FMT is a safe and effective therapy against CDI for patients with CLD and cirrhosis.

Fecal Microbiota Transplantation Is Safe and Effective in Patients With Clostridioides difficile Infection and Cirrhosis

“…In another series, of which 9 patients had cirrhosis, there was no significant worsening of Child-Pugh scores after FMT, though specific data about adverse events was not tabulated. 32 Specific AE data were collected by Bajaj and colleagues in a phase 1, randomized, placebo-controlled trial of FMT for HE. 33 In this study, SAEs (defined as hospitalizations and emergency room visits) occurred in 6/10 patients who received placebo, and only 1/10 patients who received FMT.…”

The microbiota in cirrhosis and its role in hepatic decompensation

“…Moreover, it has been successfully used to treat concomitant C. difficile. [84][85][86] Several more studies are being planned or are in process to leverage this exciting approach. 87 Most current studies are small-scale, illustrating the first important step of any investigation, i.e.…”

Romanian National Guideline on Translating Fecal Microbiota Transplantation Applications related to Clostridioides difficile Infections into the Local Clinical Practice

“…A study including cirrhotic patients, aiming to assess safety, tolerability and impact on microbiota and brain function in hepatic encephalopathy of capsulated FMT, demonstrated that oral FMT capsules appear to be safe, and even improved EncephalApp performance [90]. Another study including patients with chronic liver disease, among which 9 with cirrhosis and 1 recipient of liver transplantation, FMT was well tolerated, without infectious complications [91].…”