Fecal microbiota transplantation for recurrent Clostridium difficile infection in patients with solid organ transplants: an institutional experience and review of the literature

Abstract

Clostridium difficile, an anaerobic gram-positive, spore-forming bacillus, has become the most common cause of nosocomial infectious diarrhea, and is associated with increased mortality in all populations. Patients who have received solid organ transplants (SOT) are at increased risk of Clostridium difficile infection (CDI) and CDI recurrence (rCDI). This may be related to chronic immunosuppression, frequent antibiotic exposure, and increased or prolonged hospitalizations. Increased morbidity and mortality from CDI is well-described in SOT patients. Conventional treatments for index and recurrent CDI include vancomycin and fidaxomicin. Fecal microbiota transplantation has emerged as an effective and safe alternative for treating rCDI in the general population. Reports of its safety in certain immunocompromised populations, such as those with inflammatory bowel disease, appear reassuring, but outcomes among SOT patients are less well known. Here, we summarize the experiences published to date on the treatment of rCDI with FMT in SOT patient, and also describe our detailed FMT protocol and experience in treating a series of SOT patients with rCDI. In addition to reporting the safety and efficacy of our FMT experience, we also discuss the diagnostic challenges and considerations in this population of solid organ transplant recipients.

Adjunctive fecal microbiota transplantation in supportive oncology: Emerging indications and considerations in immunocompromised patients

“…FMT for the treatment of immunocompromised patients has been met with caution due to the perceived risk of bacterial translocation and sepsis. However, systematic review data suggest that FMT for the treatment of CDI in immunocompromised patients is feasible and safe, describing similar rates of serious adverse events to immunocompetent patients [24,25]. A systematic review identified 44 articles in which FMT had been performed for CDI in 303 immunosuppressed patients.…”

Fecal Microbiota Transplantation: Is It Safe?

“…13 However, the transmission of live microorganisms to recipients with underlying illnesses presents a greater potential risk. 14,15 For example, clinicians should consider the possible transmission of the Epstein-Barr virus and cytomegalovirus from donors in immunosuppressed FMT recipients, for which recent guidelines recommend additional donor screening. 16 Several risks are mitigated by implementing a careful selection and screening process for prospective donors.…”

The Role of Gut Microbiota in Overcoming Resistance to Checkpoint Inhibitors in Cancer Patients: Mechanisms and Challenges

“…Several clinical trials assessing the role of FMT in the response of patients to CPIs are currently ongoing. While its safety has been demonstrated even in immunocompromised patients, attention should be paid in the future regarding the possible complications of FMT, as some cases of FMT were reported to induce bacteremia through an unclear mechanism [ 112 , 115 ]. Three important points should be considered prior to FMT administration: the screening of the bacterial constituents of the FMT, the removal of harmful pathogens (bacteria, viruses, or parasites), and the possible isolation of cultivation of less abundant but beneficial microorganisms [ 116 ].…”