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

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

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Digestive Diseases Week
May 16–19, 2015, Washington, DC

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 literature1-3 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.