- Fecal microbiota transplantation (FMT) appears to offer a simple solution to the complex problem of Clostridium difficile infection in patients with liver disease.
Why this matters
- Patients with cirrhosis and C difficile infection have longer hospital stays and higher mortality compared with those without liver disease.
- Fecal microbiota transplantation is known to be effective in the treatment of C difficile infection in noncirrhotic patients.
- This study shows a similar benefit in those with liver disease.
- Large multicenter cohort study.
- Retrospective study of 69 cirrhotic patients who received FMT for C difficile infection.
- 88.4% of patients had recurrent C difficile infection. The remainder had either severe or fulminant forms of the infection.
- 34.8% had decompensated cirrhosis, most commonly due to nonalcoholic steatohepatitis (NASH) or alcohol.
- FMT was delivered via colonoscopy.
- 84.1% achieved cure of the infection.
- 10/11 FMT failures achieved cure with retreatment and antibiotic taper.
- Moderate adverse events included self-limited abdominal discomfort, bloating, and/or diarrhea.
- 2 serious adverse events possibly related to FMT occurred: a Crohn’s disease flare and hypotension with acute kidney injury.
- The study was a retrospective. A prospective study is needed to confirm these results.