Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy
<b>Background and Aims:</b> Due to increasing knowledge of the “gut–liver axis”, there has been growing interest regarding the use of fecal microbiota transplant in the management of chronic liver disease. There are limited data available and current guidelines are mostly based on expert...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/11/7/838 |
| _version_ | 1827619248478879744 |
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| author | Annie S. Hong Kyaw Min Tun Jenny M. Hong Kavita Batra Gordon Ohning |
| author_facet | Annie S. Hong Kyaw Min Tun Jenny M. Hong Kavita Batra Gordon Ohning |
| author_sort | Annie S. Hong |
| collection | DOAJ |
| description | <b>Background and Aims:</b> Due to increasing knowledge of the “gut–liver axis”, there has been growing interest regarding the use of fecal microbiota transplant in the management of chronic liver disease. There are limited data available and current guidelines are mostly based on expert opinions. We aim to perform the first systematic review investigating safety and efficacy of fecal microbiota transplant particularly among high-risk decompensated cirrhosis patient populations. <b>Methods</b>: Literature search was performed using variations of the keywords “fecal microbiota transplant” and “cirrhosis” on PubMed/Medline from inception to 3 October 2021. The resulting 116 articles were independently screened by two authors. In total, 5 qualifying studies, including 2 randomized control trials and 3 retrospective case series, were found to meet established eligibility criteria and have adequate quality of evidence to be included in this review. <b>Results</b>: Of the total 58 qualifying patients, there were 2 deaths post fecal microbiota transplant, 1 of which could not rule out being related (1.7%). Among the remaining 56 participants, 8 serious adverse events were reported, of which 2 could not rule out being related (3.6%). The success rate of fecal microbiota transplantation in treating recurrent <i>Clostridioides difficile</i> infection among patients with decompensated cirrhosis was 77.8%. The success rate when used as investigational treatment for hepatic encephalopathy was 86.7%, with multiple studies reporting clinically significant improvement in encephalopathy testing scores. <b>Conclusions</b>: We found a marginally higher rate of deaths and serious adverse events from fecal microbiota transplant in our patient population compared with the average immunocompetent population, where it was previously found to have 0 deaths and SAE rate of 2.83%. The efficacy when used for recurrent <i>C.</i><i>difficile</i> infection was 77.8% and 87% in the decompensated cirrhotic and general populations, respectively. Studies on efficacy in novel treatment of hepatic encephalopathy have been promising. This study concludes that fecal microbiota transplant use in decompensated cirrhosis patients should be used with caution and preferably be limited to research purposes until better data are available. |
| first_indexed | 2024-03-09T10:24:36Z |
| format | Article |
| id | doaj.art-bb2006665d134bd197c3adccea8e091c |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-09T10:24:36Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-bb2006665d134bd197c3adccea8e091c2023-12-01T21:48:50ZengMDPI AGAntibiotics2079-63822022-06-0111783810.3390/antibiotics11070838Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and EfficacyAnnie S. Hong0Kyaw Min Tun1Jenny M. Hong2Kavita Batra3Gordon Ohning4Department of Gastroenterology, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USADepartment of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USADepartment of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USADepartment of Medical Education, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USADepartment of Gastroenterology, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA<b>Background and Aims:</b> Due to increasing knowledge of the “gut–liver axis”, there has been growing interest regarding the use of fecal microbiota transplant in the management of chronic liver disease. There are limited data available and current guidelines are mostly based on expert opinions. We aim to perform the first systematic review investigating safety and efficacy of fecal microbiota transplant particularly among high-risk decompensated cirrhosis patient populations. <b>Methods</b>: Literature search was performed using variations of the keywords “fecal microbiota transplant” and “cirrhosis” on PubMed/Medline from inception to 3 October 2021. The resulting 116 articles were independently screened by two authors. In total, 5 qualifying studies, including 2 randomized control trials and 3 retrospective case series, were found to meet established eligibility criteria and have adequate quality of evidence to be included in this review. <b>Results</b>: Of the total 58 qualifying patients, there were 2 deaths post fecal microbiota transplant, 1 of which could not rule out being related (1.7%). Among the remaining 56 participants, 8 serious adverse events were reported, of which 2 could not rule out being related (3.6%). The success rate of fecal microbiota transplantation in treating recurrent <i>Clostridioides difficile</i> infection among patients with decompensated cirrhosis was 77.8%. The success rate when used as investigational treatment for hepatic encephalopathy was 86.7%, with multiple studies reporting clinically significant improvement in encephalopathy testing scores. <b>Conclusions</b>: We found a marginally higher rate of deaths and serious adverse events from fecal microbiota transplant in our patient population compared with the average immunocompetent population, where it was previously found to have 0 deaths and SAE rate of 2.83%. The efficacy when used for recurrent <i>C.</i><i>difficile</i> infection was 77.8% and 87% in the decompensated cirrhotic and general populations, respectively. Studies on efficacy in novel treatment of hepatic encephalopathy have been promising. This study concludes that fecal microbiota transplant use in decompensated cirrhosis patients should be used with caution and preferably be limited to research purposes until better data are available.https://www.mdpi.com/2079-6382/11/7/838fecal microbiota transplantdecompensated cirrhosis<i>Clostridioides difficile</i> infectionhepatic encephalopathy |
| spellingShingle | Annie S. Hong Kyaw Min Tun Jenny M. Hong Kavita Batra Gordon Ohning Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy Antibiotics fecal microbiota transplant decompensated cirrhosis <i>Clostridioides difficile</i> infection hepatic encephalopathy |
| title | Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy |
| title_full | Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy |
| title_fullStr | Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy |
| title_full_unstemmed | Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy |
| title_short | Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy |
| title_sort | fecal microbiota transplantation in decompensated cirrhosis a systematic review on safety and efficacy |
| topic | fecal microbiota transplant decompensated cirrhosis <i>Clostridioides difficile</i> infection hepatic encephalopathy |
| url | https://www.mdpi.com/2079-6382/11/7/838 |
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