Fecal microbiota transplantation donation: the gift that keeps on giving
Graphical abstract
Introduction
Fecal microbiota transplantation (FMT) is donation of stool from a healthy donor to another individual and can be performed via several routes including colonic, nasogastric or oral. The healthy stool is transplanted using nasogastric (NG) or nasojejunal tubes, oral capsules, enemas and endoscopic techniques including upper gastrointestinal (GI) endoscopy, sigmoidoscopy, and colonoscopy. While FMT has been most commonly studied for individuals suffering from recurrent Clostridium difficile infections (CDI), newer studies are emerging for utilization of FMT for other conditions such as inflammatory bowel disease (IBD), diabetes mellitus, autistic spectrum of disorders, myasthenia gravis, rheumatoid arthritis, and even possibly for obesity [1, 2, 3, 4, 5, 6].
The efficacy of FMT for refractory cases of CDI demonstrates cure rates of up to 90% [7,8•]. Given this, FMT is an exciting and novel therapy which can treat nearly the half million individuals infected annually and prevent the 15 000 deaths attributed to this infection [9]. As of February 2019, there were 225 clinical trials registered on www.clinicaltrials.gov that are studying FMT for various therapeutic uses. This was a 28-trial increase from September 2016 and still encompasses indications including type II diabetes mellitus, IBD, hepatic encephalopathy, alcoholic hepatitis, and dependence, and primary sclerosing cholangitis. Importantly, as with any transplant procedure, donors and donations must be evaluated for the risks, benefits, costs, safety, availability, and accessibility, which will be the focus of this paper.
Section snippets
Cost
With any form of transplantation, there is a significant cost burden. Interestingly, this cost usually falls upon the recipient of the transplanted substance. Yet, with FMT there is cost to the donor regarding screening for infectious states and other conditions. For example, Kazerouni et al. determined that it costs $50 for clinical assessment, $600 for stool tests, and $235 for serum tests; Craven et al. found that cost for finding a suitable donor was $15 190 [10•,11••]. Most screening
Safety and accessibility
Certainly, safety is paramount when discussing treatment options for any symptom or disease. Fortunately, serious adverse events (AE) are more commonly encountered due to the procedures performed for the transplantation than the stool material itself, and studies before 1999 did not include AE in regards to donor screening [8•,20]. Such an example of AE includes aspiration of fecal contents with NG administration. Yet, one of the pioneer studies done by van Nood’s group stopped their randomized
Conclusion
In summary, currently it is recommended that either individual or stool bank donors be less than 60 years of age (may change efficacy of FMT, and could increase risk of colorectal cancer), have not had risk factors nor exposure to infectious diseases (i.e. Creutzfeldt-Jacob, Human Immunodeficiency Virus, viral hepatitis, C. difficile), have passed extensive laboratory and stool testing (including but not limited to parasites, C. difficile, enteropathogenic bacteria, HIV, Human T-Cell
Author contributions
All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and approval of the final version.
Conflict of interest statement
Nothing declared.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
References and recommended reading
Papers of particular interest, published within the period of review, have been highlighted as:
• of special interest
•• of outstanding interest
Acknowledgement
None.
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