Does the Donor Matter? Donor vs. Patient Effects in the Outcome of Next-Generation Fecal Transplant for Recurrent Clostridium difficile Infection

Courtney Jones, BS, Robert Hardi, MD, Bill Shannon, PhD, Rebiotix Inc., Roseville, MN; Capital Digestive Care, BioRankings LLC, St. Louis, MO

Background

• Fecal microbiota transplantation (FMT) is becoming an increasingly accepted treatment for recurrent Clostridium difficile infection (CDI).
• Overall resolution rates in the range of 90% have been reported in the literature^1-3 though multiple doses may be necessary to achieve this cure rate.^4-5
• There are still many unknowns about the therapy including questions about donor vs. patient factors in therapy success.
• Conventional procedure has been to use a second donor in case of treatment failure.
• The relative importance of the donor was assessed in the context of a Phase 2 study of a next-generation FMT drug.

References

1. Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clinical Infectious Diseases 2011 ;53(10):994–1002.
2. Kassam Z, Lee CH, Yuan Y, et al. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol . 2013;108:500–508.
3. Keller JJ, Kuijper EJ. Treatment of recurrent and severe Clostridium difficile infection. Annu Rev Med . 2015;66:373-86.
4. van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile . N Engl JMed . 2013;368:407–415.
5. Lee CH, Belanger JE, Kassam Z et al. The outcome and long-term follow-up of 94 patients with recurrent and refractory Clostridium difficile infection using single to multiple fecal microbiota transplantation via retention enema. Eur J Clin Microbiol Infect Dis. 2014;33(8):1425-8.