Lessons Learned from Faecal Microbiota Transplantation in Cirrhosis
- PDF / 627,291 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 65 Downloads / 184 Views
MANAGEMENT OF THE CIRRHOTIC PATIENT (A CARDENAS AND P TANDON, SECTION EDITORS)
Lessons Learned from Faecal Microbiota Transplantation in Cirrhosis Grace B. Hatton 1 & Shaolu Ran 1 & Thomas H. Tranah 1 & Debbie L. Shawcross 1
# The Author(s) 2020
Abstract Purpose of Review We examine recent developments in the treatment of cirrhosis by gut microbiome manipulation specifically focusing on the phase 1 safety and feasibility trials of faecal microbiota transplantation (FMT). We interrogate the published data so far on its feasibility, safety and efficacy. Recent Findings A large number of trials have demonstrated the efficacy of FMT in treating recurrent Clostridium difficile infection which is now considered standard of care. In cirrhosis, FMT is still being evaluated and there are a number of clinical trials underway. There are two phase 1 pilot safety studies that have been published with promising findings. However, the importance of rigorously testing donor stool for the presence of multi-drug resistant species has been highlighted and lessons have been learned. Summary For those patients with cirrhosis, replacing an unhealthy gut microbiome with a healthy one offers a promising antibiotic-free treatment that may reduce bacterial translocation and endotoxemia. Keywords Cirrhosis . Dysbiosis . Faecal microbiota transplantation . Gut dysbiosis . Hepatic encephalopathy
Introduction
Poor Outcomes in Chronic Liver Disease
Global Chronic Liver Disease Crisis
In the UK, 70% of patients with cirrhosis die in hospital and while one in five of those who die have had five or more admissions to hospital in the last year of life, one in five are admitted only once and die during that first admission [2]. Cirrhosis is associated with an increased incidence of infection resulting in hospitalisation and complicating hospital admissions in up to 40% of cases [3]. Infection can lead to worsening liver function and precipitate complications including variceal bleeding, HE, acute kidney injury and multiorgan failure, contributing to high mortality [4]. Patients with cirrhosis admitted to intensive care have an overall survival until hospital discharge of only 51% [5].
Cirrhosis reflects the clinical endpoint of advanced-stage liver disease, uncompromisingly characterised by a myriad of debilitating and largely irreversible symptoms. Typically, these symptoms range from immune dysregulation and infection to bleeding, fluid overload, hepatic encephalopathy (HE), endorgan failure and, ultimately, death. Treatment options are all the more limited with disease progression, and without access to liver transplantation, prognosis is invariably bleak. Equally, cirrhosis is gaining rapid traction as one of the biggest contributors to mortality worldwide [1].
Grace B. Hatton and Shaolu Ran contributed equally to this work. This article is part of the Topical Collection on Management of the Cirrhotic Patient * Debbie L. Shawcross [email protected] 1
Institute of Liver Studies, Department of Inflammation Biology, School of Immu
Data Loading...
