In the Journals

FMT appears safe, reduces hepatic encephalopathy recurrence in long-term

Jasmohan S. Bajaj, MD
Jasmohan S. Bajaj

Fecal microbiota transplant after antibiotic treatment may be safe and potentially prevent long-term recurrence of hepatic encephalopathy in patients with cirrhosis, according to extended data from a previously published study.

“The current study extends the experience of the first randomized clinical trial of FMT after antibiotics in cirrhosis and recurrent [hepatic encephalopathy (HE)] over more than 12 months,” Jasmohan S. Bajaj, MD, from the Virginia Commonwealth University and McGuire VA Medical Center, and colleagues wrote.

In the published safety trial, investigators randomly assigned 10 patients with recurrent HE each to receive either pretreatment antibiotics and FMT or standard of care. Results showed FMT to be safe and provided short-term improvement in cognitive function and reduced hospitalizations.

The extended results included follow-up data from a range of 12 months to 15 months posttreatment.

During follow-up, the standard of care group saw more total hospitalizations (10 vs. 1; P = .05) and HE events (8 vs. 0; P = .03) than the FMT group. MELD score changes from pre-intervention to long-term posttreatment were similar in both groups. Cognitive function improved in the FMT group by day 20 posttreatment and was significantly better than the standard of care group.

“From a microbiome perspective there were differences in profiles between the [standard of care] and FMT arms at long-term analysis, but not in Lachnospiraceae and Ruminococcaceae relative abundance,” Bajaj and colleagues wrote. “These results are unlikely due to mitigation of PPI microbiome effect and extend prior FMT studies where the ultimate microbial profile may not precisely reflect the donor to result in benefit. Functional evaluation is therefore needed to understand the potential mechanisms of action of microbiome therapeutics.” – by Talitha Bennett

Disclosure: Bajaj reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

Editor's note: This article was updated to clarify improvement in cognitive function and reduction of hospitalizations.

Jasmohan S. Bajaj, MD
Jasmohan S. Bajaj

Fecal microbiota transplant after antibiotic treatment may be safe and potentially prevent long-term recurrence of hepatic encephalopathy in patients with cirrhosis, according to extended data from a previously published study.

“The current study extends the experience of the first randomized clinical trial of FMT after antibiotics in cirrhosis and recurrent [hepatic encephalopathy (HE)] over more than 12 months,” Jasmohan S. Bajaj, MD, from the Virginia Commonwealth University and McGuire VA Medical Center, and colleagues wrote.

In the published safety trial, investigators randomly assigned 10 patients with recurrent HE each to receive either pretreatment antibiotics and FMT or standard of care. Results showed FMT to be safe and provided short-term improvement in cognitive function and reduced hospitalizations.

The extended results included follow-up data from a range of 12 months to 15 months posttreatment.

During follow-up, the standard of care group saw more total hospitalizations (10 vs. 1; P = .05) and HE events (8 vs. 0; P = .03) than the FMT group. MELD score changes from pre-intervention to long-term posttreatment were similar in both groups. Cognitive function improved in the FMT group by day 20 posttreatment and was significantly better than the standard of care group.

“From a microbiome perspective there were differences in profiles between the [standard of care] and FMT arms at long-term analysis, but not in Lachnospiraceae and Ruminococcaceae relative abundance,” Bajaj and colleagues wrote. “These results are unlikely due to mitigation of PPI microbiome effect and extend prior FMT studies where the ultimate microbial profile may not precisely reflect the donor to result in benefit. Functional evaluation is therefore needed to understand the potential mechanisms of action of microbiome therapeutics.” – by Talitha Bennett

Disclosure: Bajaj reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

Editor's note: This article was updated to clarify improvement in cognitive function and reduction of hospitalizations.