Fecal transplant outcomes not impacted by donor profile

WASHINGTON — Fecal transplant donor profile does not appear to impact clinical outcomes in the treatment of Clostridium difficile infection, according to research presented at Digestive Disease Week.

Shrish Budree, MD, of OpenBiome and the University of Cape Town, South Africa, said success of fecal microbiota transplantation in the treatment of CDI is more likely due to other factors, such as clinical practice and accurate diagnosis.

The investigators analyzed data from patients who underwent FMT for CDI at 267 health care centers between January 2014 and April 2016. They collected information on CDI disease type, FMT delivery modality and physician-reported clinical outcomes and linked them to an individual stool donor. Then, they calculated overall and per donor efficacy rates.

Budree and colleagues identified 51 donors whose stool was used to treat 2,050 patients with CDI.

When they compared individual cure rates for each donor, they found that there was one donor, “Donor X,” who had a significantly lower crude efficacy rate of around 70% compared with the mean donor cure rate of 85.3% (P = .007).

They looked at the donor’s microbiome diversity and found that the donor had a slightly higher alpha diversity compared with the mean of the other donors, although not significantly.

“This donor looked no different in terms of their microbiome compared to all the other donors,” Budree said in his presentation.

When they looked at clinical data and controlled for CDI disease type, delivery modality and health care facility, the researchers found that Donor X was no longer statistically significant in predicting clinical outcome in CDI.

“The variations that we were seeing in donor efficacy were likely not driven by the donor microbial community or microbial profile,” Budree said. “But more likely, by recipient factors or clinical which may drive the outcome in C. diff infection.”

Budree said their findings underline the importance of universal stool banks conducting quality assurance evaluation of their donor’s efficacy. – by Alex Young

Reference:

Osman M, et al. Abstract 88. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosures: Budree is a senior clinical research scientist at OpenBiome. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.

Editor's note: This article was updated on June 13 to correct Budree's university affiliation.