DDW 2019—Fecal transplantation effective against C difficile in cirrhosis patients


  • Sean Henahan
  • Conference Reports
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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.

Limitations

  • The study was a retrospective. A prospective study is needed to confirm these results.

 

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