Long-Term Follow-Up of Fecal Microbiota Transplantation for Treatment of Recurrent Clostridium difficile Infection in a Dual Solid Organ Transplant Recipient

Abstract

Clostridium difficile infection is one of the most frequent causes of healthcare-associated infections, and its rates are also increasing in the community. Mounting evidence suggests that fecal microbiota transplantation (FMT) may be effective; however, as there is paucity of data regarding the use of FMT in patients with solid organ transplants, we present a case of successful FMT in a patient with dual solid organ transplant.

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

“…One case report described a pediatric heart transplant patient with rCDI who required two FMTs (delivered by rectal enemas) to adequately reconstitute colonic microbial diversity with the phylas Firmicutes, Bacteroidetes and families Lachnospiraceae and Ruminococcaceae . Other case reports vary by the route of FMT delivery—endoscopically into the duodenum, through a naso‐jejunal tube, during colonoscopy, and via flexible sigmoidoscopy or with oral capsules . Cure rates range from 50% to 100% depending on the length of follow‐up (ranging from 8 weeks to 2.5 years) …”

“…Other case reports vary by the route of FMT delivery—endoscopically into the duodenum, through a naso‐jejunal tube, during colonoscopy, and via flexible sigmoidoscopy or with oral capsules . Cure rates range from 50% to 100% depending on the length of follow‐up (ranging from 8 weeks to 2.5 years) …”

“…Currently, there are only a handful of studies on the utility and outcome of FMT in the SOT population specifically, and most are with limited follow-up intervals 35,[42][43][44][45] (see Table 3). Early case reports demonstrated the safety and feasibility of FMT in this population.…”

“…45 Cure rates range from 50% to 100% depending on the length of follow-up (ranging from 8 weeks to 2.5 years). 18,35,[42][43][44][45] In recent years, two larger cohorts of patients with SOT receiv- follow-up intervals. The largest, multicentered cohort to date documents 80 immunocompromised patients.…”

The epidemiology of Clostridium difficile infection in a national kidney transplant center

“…Unlike some macrolide antibiotics, fidaxomicin did not have a demonstrable effect on tacrolimus trough concentrations . There have also been a small number of case reports detailing successful fecal microbiota transplantation in the setting of recurrent CDI in transplant recipients …”