Systematic review with meta‐analysis: review of donor features, procedures and outcomes in 168 clinical studies of faecal microbiota transplantation

Abstract

Summary Background Faecal microbiota transplantation (FMT) is effective for Clostridium difficile infections (CDI) refractory to standard treatment and is being studied in other diseases. Aim To evaluate donor characteristics, procedures and clinical outcomes of FMT. Methods We systematically reviewed FMT studies published up to 29 August 2018 using MEDLINE (R) and EMBASE and identified clinical studies with FMT donor information. We reported data on donor characteristics, screening criteria, administration, clinical outcomes and adverse events. Results Among 5267 reports, 239 full‐text articles were screened and 168 articles were included. FMT was performed commonly for CDI (n = 108) and inflammatory bowel disease (IBD) (n = 31). We reported characteristics of 1513 donors [58% male; mean age, 34.3 years; mean body mass index, 21.6]. Donors in Asia were younger than the West (mean age 30.7 vs 32.9, P = 0.00075). Less than 50% of studies screened donors for transmittable pathogens. Final cure rate for CDI was 95.6% (95% confidence interval [CI], 93.9%‐97.1%) and final remission rates for ulcerative colitis (UC) and Crohn's disease (CD) were 39.6% (95% CI, 25.4%‐54.6%) and 47.5% (95% CI, 29.4%‐65.8%), respectively. Cure rates in CDI and final remission rates for CD and UC were comparable across all routes of FMT administration. Overall adverse event incidence was <1%, mostly GI‐related. Adverse event rates did not differ significantly between routes of FMT administration or indication. Conclusions In a systematic review assessing donor characteristics and FMT efficacy, we observed heterogeneity in donor selection, application and outcomes of FMT. These data can facilitate standardisation of FMT protocols for various diseases.

In search of stool donors: a multicenter study of prior knowledge, perceptions, motivators, and deterrents among potential donors for fecal microbiota transplantation

“…2,8 Fecal microbiota transplantation (FMT) is a highly effective therapy for patients with recurrent C. difficile infection, with a greater than 90% success rate. [9][10][11][12] Emerging evidence suggests that FMT may also have therapeutic benefits in other conditions associated with perturbed gut microbiota, including ulcerative colitis, [13][14][15][16] Crohn's disease, 17 irritable bowel syndrome, 18 metabolic syndrome, 19,20 multiple sclerosis, 21,22 depression, 23 and autism. 24,25 Intense interest in FMT is evident, with over 250 clinical trials registered on of January 11, 2019.…”

Gut microbiota and butyrate contribute to nonalcoholic fatty liver disease in premenopause due to estrogen deficiency

“…Gut microbiota-targeted interventions may prove to be an effective and innovative approach for treating NAFLD. FMT has been shown to be effective in the treatment of severe gastrointestinal diseases [30]. Le Roy et al [31] showed that susceptibility to the development of NAFLD was transmissible via FMT between mice, indicating a potential causative role for gut microbial dysbiosis in the occurrence or evolution of the hepatic disease.…”

Mikrobiota und Reizdarmsyndrom – eine kritische Bestandsaufnahme

“…Dazu gehört auch, dass FMT-Sets für die Selbsttherapie im Internet erhältlich sind, auch wenn (oder vielleicht weil) es inzwischen Standards und ethisch-rechtliche Regelungen in den meisten Ländern gibt. Voraussetzung für eine wissenschaftliche Weiterentwicklung dieser Therapie sind sicherlich präzisere Informationen darüber, wann und unter welchen Konditionen FMT wirksam ist [46]. [22].…”