microbiota transplantation

Gastroenterology

Recurrent hepatic encephalopathy (HE) leads to significant disability and mortality despite standard of care (SOC), that is, lactulose and add-on rifaximin.1Vilstrup H. et al.Hepatology. 2014; 60: 715-735Crossref PubMed Scopus (1107) Google Scholar It is associated with impairment of the gut–liver–brain axis, and fecal microbiota transplantation (FMT) may be useful. In recurrent Clostridium difficile, a single FMT has sustained cure rates of greater than 80% with a tolerable long-term safety profile.2Kelly C.R. et al.Gastroenterology. 2015; 149: 223-237Abstract Full Text Full Text PDF PubMed Scopus (397) Google Scholar In a published safety trial, 10 recurrent HE participants each were randomly assigned to receive pretreatment antibiotics and FMT or to receive SOC, which was safe. As a secondary outcome, there was an improvement in short-term cognitive function and hospitalizations.3Bajaj J.S. et al.Hepatology. 2017; Google Scholar However, the long-term impact of FMT is unclear. Our aim was to determine the long-term impact of FMT on cognition, hospitalizations, and HE by extending the results of this trial.3Bajaj J.S. et al.Hepatology. 2017; Google Scholar For rational donor selection, the microbiome profiles of HE patients and healthy control individuals were assessed. HE patients showed a relative reduction of Lachnospiraceae and Ruminococcaceae species compared with control individuals. Leveraging the cross-sectional microbiome data, a donor was selected from the donor database by using random forest analysis, to complement the relative deficiencies of the patient microbiota.3Bajaj J.S. et al.Hepatology. 2017; Google Scholar The same donor was used for all FMT-assigned participants. These participants underwent 5 days of pre-FMT antibiotics, after which 90 mL (27 g of stool) of the donor material containing approximately 2.7 × 1012 colony-forming units was administered via enema. SOC participants did not undergo any interventions or antibiotic therapy. All participants were followed up in keeping with the vi...

Long-term Outcomes of Fecal Microbiota Transplantation in Patients With Cirrhosis