Successful outcomes of fecal microbiota transplantation in patients with chronic liver disease
Meighani A, Ramesh M, and Salgia R. Successful outcomes of fecal microbiota transplantation in patients with chronic liver disease. Hepatology 2016; 63(1):1016A-1017A.
Background: Fecal Microbiota Transplantation (FMT) has been shown to be a promising treatment option for patients with recurrent and/ or refractory Clostridium Difficile Infection (CDI). Despite increasing research on FMT, little is known about outcomes in patients with liver disease or cirrhosis. We aimed to study the outcomes of FMT in patients with chronic liver disease (CLD) at our tertiary medical center. Methods: A cohort of all patients who had undergone FMT from December 2012 to May 2014 for refractory or recurrent CDI was identified. Patients were followed up for 1 year post-FMT. Response to treatment was defined as resolution of symptoms in 7 days. Severe CDI was defined as a rise in creatinine >1.5 times above baseline, WBC ≥ 15,000 cells/mL, or albumin < 1.5 g/ dl within 2 weeks of symptom onset. Descriptive analysis was performed to determine the outcomes of FMT in patients with CLD as compared to the comparison cohort without liver disease. Results: A total of 201 patients underwent FMT for CDI, from which 14 had a history of chronic liver disease. Nine of these patients had cirrhosis with a mean Child-Turcotte-Pugh (CTP) score of 8. One patient was 5 months post-liver transplant at the time of FMT. Mean age of patients in the liver disease cohort was 62 with 71% being female. Recent antibiotic use was a common risk factor related to CDI development and was found to be significantly different between both groups (17% of CLD patients vs 58% in the general cohort, p= 0.01). Although some patients were immunosuppressed due to history of IBD or liver transplant, there was no significant difference between the two groups and their outcomes in terms of immunosuppression, route of FMT delivery, number of CDI infections within the prior 3 months, recent hospitalization, recent surgeries or Charlson comorbidity index. There was no significant difference in the number of patients with severe grading of CDI among patients with CLD and the general cohort (36% vs 24%, p= 0.34). Four patients with CLD received >1 FMT, of which 2 remained non-responders. Overall, there was no significant difference in FMT response between patients with liver disease and the rest of the cohort (12/14, 87% vs 164/187, 88%, p= 0.68). Both patients who failed FMT in the CLD cohort had decompensated cirrhosis with CTP scores of 9 and 12, respectively. Conclusion: Fecal microbiota transplantation is a safe and successful treatment option for patients with recurrent and/or refractory CDI who have stable chronic liver disease or compensated cirrhosis. Recent antibiotic use was less commonly a risk factor for CDI in patients with liver disease.