Fecal Microbiota Transplantation Donor Screening Updates and Research Gaps for Solid Organ Transplant Recipients

• Authors: Christian Larsen, Emory University; Nadine Rouphael, Emory University; Colleen Kraft, Emory University; Tanvi Dhere, Emory University; Michael Woodworth, Emory University; Nirja Mehta, Emory University; Tiffany Wang, Emory University; Rachel Friedman-Moraco, Emory University; Cynthia Carpentieri, Emory University; Aneesh Mehta, Emory University
• Journal Title: JOURNAL OF CLINICAL MICROBIOLOGY
• Volume: Volume 60, Number 2
• Publisher: AMER SOC MICROBIOLOGY | 2022-02-01, Pages e0016121-e0016121
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1128/JCM.00161-21
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Pathology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Microbiology; Clostridium difficile; fecal microbiota transplant; solid organ transplant; transplant infectious diseases; CLOSTRIDIUM-DIFFICILE INFECTION; EPSTEIN-BARR-VIRUS; STOOL SAMPLES; RECURRENT; POLYOMAVIRUS; BK; CYTOMEGALOVIRUS; OUTCOMES; COLITIS; BLOOD

Abstract

In this review, we discuss stool donor screening considerations to mitigate potential risks of pathogen transmission through fecal microbiota transplant (FMT) in solid organ transplant (SOT) recipients. SOT recipients have a higher risk for Clostridioides difficile infection (CDI) and are more likely to have severe CDI. FMT has been shown to be a valuable tool in the treatment of recurrent CDI (RCDI); however, guidelines for screening for opportunistic infections transmitted through FMT are underdeveloped. We review reported adverse effects of FMT as they pertain to an immunocompromised population and discuss the current understanding and recommendations for screening found in the literature while noting gaps in research. We conclude that while FMT is being performed in the SOT population, typically with positive results, there remain many unanswered questions which may have major safety implications and warrant further study.