PMID- 32645451 OWN - NLM STAT- MEDLINE DCOM- 20210909 LR - 20220802 IS - 1542-7714 (Electronic) IS - 1542-3565 (Print) IS - 1542-3565 (Linking) VI - 19 IP - 8 DP - 2021 Aug TI - Fecal Microbiota Transplantation Is Safe and Effective in Patients With Clostridioides difficile Infection and Cirrhosis. PG - 1627-1634 LID - S1542-3565(20)30915-0 [pii] LID - 10.1016/j.cgh.2020.06.051 [doi] AB - BACKGROUND & AIMS: Clostridioides difficile infection (CDI) harms a large proportion of patients with cirrhosis. Fecal microbiota transplantation (FMT) is recommended for recurrent CDI, but its effects in patients with cirrhosis have not been established. We performed a multicenter observational study to evaluate the efficacy and safety of FMT for CDI in patients with cirrhosis. METHODS: We performed a retrospective study of 63 adults with cirrhosis (median model for end-stage liver disease score, 14.5; 24 patients with decompensated cirrhosis) who underwent FMT for CDI from January 2012 through November 2018 at 8 academic centers in the United States, Canada, and Italy. We collected data on patient demographics and characteristics of cirrhosis, CDI, and FMT from medical records and compared differences among patients with different severities of cirrhosis, and FMT successes vs failures at the 8-week follow-up evaluation. We also obtained data on adverse events (AEs) and severe AEs within 12 weeks of FMT. RESULTS: Patients underwent FMT for recurrent CDI (55 of 63; 87.3%), severe CDI (6 of 63; 9.5%), or fulminant CDI (2 of 63; 3.2%) primarily via colonoscopy (59 of 63; 93.7%) as outpatients (47 of 63; 76.8%). FMT success was achieved for 54 patients (85.7%). Among FMT failures, a higher proportion used non-CDI antibiotics at the time of FMT (44.4% vs 5.6%; P < .001), had Child-Pugh scores of B or C (100% vs 37.7%; P < .001), used probiotics (77.8% vs 24.1%; P = .003), had pseudomembranes (22.2% vs 0; P = .018), and underwent FMT as inpatients (45.5% vs 19%; P = .039), compared with FMT successes. In multivariable analysis, use of non-CDI antibiotics at the time of FMT (odds ratio, 17.43; 95% CI, 2.00-152.03; P = .01) and use of probiotics (odds ratio, 11.9; 95% CI, 1.81-78.3; P = .01) were associated with a greater risk of FMT failure. FMT-related AEs occurred in 33.3% of patients (21 of 63)-most were self-limited abdominal cramps or diarrhea. There were only 5 severe AEs that possibly were related to FMT; none involved infection or death. CONCLUSIONS: In a retrospective study, we found FMT to be safe and effective for the treatment of CDI in patients with cirrhosis. CI - Copyright (c) 2021 AGA Institute. Published by Elsevier Inc. All rights reserved. FAU - Cheng, Yao-Wen AU - Cheng YW AD - Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana. FAU - Alhaffar, Dana AU - Alhaffar D AD - Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana. FAU - Saha, Srishti AU - Saha S AD - Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. FAU - Khanna, Sahil AU - Khanna S AD - Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. FAU - Bohm, Matthew AU - Bohm M AD - Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana. FAU - Phelps, Emmalee AU - Phelps E AD - Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana. FAU - Ghabril, Marwan AU - Ghabril M AD - Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana. FAU - Orman, Eric AU - Orman E AD - Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana. FAU - Sashidhar, Sagi AU - Sashidhar S AD - Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana. FAU - Rogers, Nicholas AU - Rogers N AD - Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana. FAU - Xu, Huiping AU - Xu H AD - Department of Biostatistics, The Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, Indiana. FAU - Khoruts, Alexander AU - Khoruts A AD - Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota. FAU - Vaughn, Byron AU - Vaughn B AD - Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota. FAU - Kao, Dina AU - Kao D AD - Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. FAU - Wong, Karen AU - Wong K AD - Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. FAU - Cammarota, Giovanni AU - Cammarota G AD - Digestive Disease Center, Gastroenterology and Oncology Area, Fondazione Policlinico Universitario "A. Gemelli", Universita Cattolica del Sacro Cuore, Rome, Italy. FAU - Ianiro, Gianluca AU - Ianiro G AD - Digestive Disease Center, Gastroenterology and Oncology Area, Fondazione Policlinico Universitario "A. Gemelli", Universita Cattolica del Sacro Cuore, Rome, Italy. FAU - Dhere, Tanvi AU - Dhere T AD - Division of Digestive Diseases, Department of Medicine. FAU - Kraft, Colleen S AU - Kraft CS AD - Division of Infectious Diseases, Department of Medicine; Department of Pathology, Emory University, Atlanta, Georgia. FAU - Mehta, Nirja AU - Mehta N AD - Division of Infectious Diseases, Department of Medicine. FAU - Woodworth, Michael H AU - Woodworth MH AD - Division of Infectious Diseases, Department of Medicine. FAU - Allegretti, Jessica R AU - Allegretti JR AD - Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. FAU - Nativ, Lotem AU - Nativ L AD - Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. FAU - Marcus, Jenna AU - Marcus J AD - Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. FAU - El-Nachef, Najwa AU - El-Nachef N AD - Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, California. FAU - Fischer, Monika AU - Fischer M AD - Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: mofische@iu.edu. LA - eng GR - K23 AI144036/AI/NIAID NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20200706 PL - United States TA - Clin Gastroenterol Hepatol JT - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JID - 101160775 SB - IM MH - Clostridioides MH - *Clostridioides difficile MH - *Clostridium Infections/therapy MH - *End Stage Liver Disease MH - Fecal Microbiota Transplantation/adverse effects MH - Humans MH - Liver Cirrhosis/complications/therapy MH - Recurrence MH - Retrospective Studies MH - Severity of Illness Index MH - Treatment Outcome PMC - PMC8856132 MID - NIHMS1777503 OTO - NOTNLM OT - Bacterial Infection OT - Infectious Diarrhea OT - Intestinal Microbiota OT - MELD EDAT- 2020/07/10 06:00 MHDA- 2021/09/10 06:00 PMCR- 2022/08/01 CRDT- 2020/07/10 06:00 PHST- 2020/01/31 00:00 [received] PHST- 2020/06/17 00:00 [revised] PHST- 2020/06/21 00:00 [accepted] PHST- 2020/07/10 06:00 [pubmed] PHST- 2021/09/10 06:00 [medline] PHST- 2020/07/10 06:00 [entrez] PHST- 2022/08/01 00:00 [pmc-release] AID - S1542-3565(20)30915-0 [pii] AID - 10.1016/j.cgh.2020.06.051 [doi] PST - ppublish SO - Clin Gastroenterol Hepatol. 2021 Aug;19(8):1627-1634. doi: 10.1016/j.cgh.2020.06.051. Epub 2020 Jul 6.