Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2017; 23(39): 7174-7184
Published online Oct 21, 2017. doi: 10.3748/wjg.v23.i39.7174
Faecal microbiota transplantation in patients with Clostridium difficile and significant comorbidities as well as in patients with new indications: A case series
Perttu Lahtinen, Eero Mattila, Veli-Jukka Anttila, Jyrki Tillonen, Matti Teittinen, Pasi Nevalainen, Seppo Salminen, Reetta Satokari, Perttu Arkkila
Perttu Lahtinen, Jyrki Tillonen, Department of Gastroenterology, Päijät-Häme Central Hospital, Lahti 15850, Finland
Eero Mattila, Veli-Jukka Anttila, Department of Infectious Diseases, Helsinki University Hospital, Helsinki 00029, Finland
Matti Teittinen, Department of Medicine, Hyvinkää Hospital 05850, Hyvinkää, Finland
Pasi Nevalainen, Department of Medicine, Tampere University Hospital 33521, Tampere, Finland
Seppo Salminen, Functional Foods Forum, University of Turku, Turku 20014, Finland
Reetta Satokari, Immunobiology Research Program, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
Perttu Arkkila, Department of Gastroenterology, Helsinki University Hospital, Helsinki 00029, Finland
Author contributions: Lahtinen P wrote the paper; Mattila E, Satokari R and Arkkila P planned the study and collected most of the data; Anttila VJ, Tillonen J and Salminen S provided their expertise in components of the article; Teittinen M and Nevalainen P contributed in collecting the data; all authors contributed to drafting the article and revised the manuscript for important intellectual content; and all of the authors approved the final version of this article.
Institutional review board statement: The study was approved by the Helsinki University Hospital Institutional Review Board.
Informed consent statement: All study participants provided informed verbal consent prior to study enrolment.
Conflict-of-interest statement: The authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Perttu Lahtinen, MD, Department of Gastroenterology, Päijät-Häme Central Hospital, Keskussairaalankatu 7, Lahti 15610, Finland.
Telephone: +358-44-7195256 Fax: +358-3-8192944
Received: July 31, 2017
Peer-review started: July 31, 2017
First decision: August 15, 2017
Revised: September 8, 2017
Accepted: September 19, 2017
Article in press: September 19, 2017
Published online: October 21, 2017

Fecal microbiota transplantation (FMT) is effective in recurrent Clostridium difficile infection (rCDI). Knowledge of the safety and efficacy of FMT treatment in immune deficient patients is scarce. FMT has been suggested as a potential method for an increasing number of new indications besides rCDI. Among our FMT-treated rCDI patients, we reviewed those with major comorbidities: two human immunodeficiency virus patients, six haemodialysis patients, two kidney transplant patients, two liver transplant patients and a patient with chronic lymphatic leukaemia. We also reviewed those treated with FMT for indications other than rCDI: Salmonella carriage (two patients), trimethylaminuria (two patients), small intestinal bacterial overgrowth (SIBO; one patient), and lymphocytic colitis (one patient), as well as a common variable immunodeficiency patient with chronic norovirus infection and ESBL-producing Escherichia coli (E. coli) carriage. Of the thirteen rCDI patients treated with FMT, eleven cleared the CDI. The observed adverse events were not directly attributable to FMT. Concerning the special indications, both Salmonellas and ESBL-producing E. coli were eradicated. One trimethylaminuria patient and one SIBO-patient reported a reduction of symptoms. Three patients did not experience a benefit from FMT: chronic norovirus, lymphocytic colitis and the other fish malodour syndrome. There were no reported side effects in this group. FMT appeared to be safe and effective for immunocompromised patients with rCDI. FMT showed promise for the eradication of antibiotic-resistant bacteria, but further research is warranted.

Keywords: Faecal microbiota transplantation, Antibiotic resistance, Clostridium difficile infection, Microbiota, Immunodeficiency, Salmonella infection

Core tip: Knowledge of faecal microbiota transplantation (FMT) in immunocompromised patients and patients with conditions other than recurrent Clostridium difficile infection (rCDI) is scarce. We reviewed 13 FMT-treated patients with rCDI and major comorbidities as well as 8 patients with new indications. In our cohort, FMT appeared to be safe and effective for immunocompromised patients: dialysis patients, human immunodeficiency virus patients, solid organ transplant patients and a patient with chronic lymphatic leukaemia. Of the patients treated for indications other than rCDI, the most promising results were successful eradication of antibiotic-resistant bacteria. Eradication of chronic Salmonella carriage in two patients with FMT represents the first cases reported to date.