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Systematic Review

Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy

1
Department of Gastroenterology, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA
2
Department of Internal Medicine, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA
3
Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
4
Department of Medical Education, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA
5
Office of Research, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA
*
Author to whom correspondence should be addressed.
Academic Editors: Wen-Chien Ko and Yuanpin Hung
Antibiotics 2022, 11(7), 838; https://doi.org/10.3390/antibiotics11070838
Received: 30 May 2022 / Revised: 17 June 2022 / Accepted: 20 June 2022 / Published: 23 June 2022
Background and Aims: 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. Methods: 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. Results: 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 Clostridioides difficile 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. Conclusions: 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 C.difficile 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. View Full-Text
Keywords: fecal microbiota transplant; decompensated cirrhosis; Clostridioides difficile infection; hepatic encephalopathy fecal microbiota transplant; decompensated cirrhosis; Clostridioides difficile infection; hepatic encephalopathy
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MDPI and ACS Style

Hong, A.S.; Tun, K.M.; Hong, J.M.; Batra, K.; Ohning, G. Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy. Antibiotics 2022, 11, 838. https://doi.org/10.3390/antibiotics11070838

AMA Style

Hong AS, Tun KM, Hong JM, Batra K, Ohning G. Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy. Antibiotics. 2022; 11(7):838. https://doi.org/10.3390/antibiotics11070838

Chicago/Turabian Style

Hong, Annie S., Kyaw M. Tun, Jenny M. Hong, Kavita Batra, and Gordon Ohning. 2022. "Fecal Microbiota Transplantation in Decompensated Cirrhosis: A Systematic Review on Safety and Efficacy" Antibiotics 11, no. 7: 838. https://doi.org/10.3390/antibiotics11070838

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