Faecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection in Patients on Long-Term Immunosuppression: A Review of Efficacy and Safety
DOI:
https://doi.org/10.5281/zenodo.22205996Keywords:
Faecal Microbiota Transplantation, Clostridioides difficile, Immunosuppression, Donor Screening, Recurrent InfectionAbstract
Faecal microbiota transplantation cures recurrent Clostridioides difficile infection more reliably than any antibiotic, but the trials that established it largely excluded the patients who recur most often. Transplanting a live, undefined microbial community into someone whose immune defences are pharmacologically suppressed raises a question the pivotal trials were never designed to answer.
Objectives:To review the published evidence on the efficacy and safety of faecal microbiota transplantation for recurrent C. difficile infection in n adults receiving long-term immunosuppression, and to set out what donor screening and follow-up that evidence supports. Material and Methods:A narrative review. MEDLINE, Embase and the Cochrane Library were searched from January 2010 to May 2026 for r randomised trials, controlled series, cohort studies and meta-analyses of faecal microbiota transplantation in recurrent C. difficile infection, together with regulatory safety communications and society guidance. Values were extracted from the primary reports and tabulated without pooling. Results:In the first randomised trial, donor infusion resolved infection in 81% after one treatment and 94% overall, against 31% for vancomycin. . Two licensed microbiota products have since shown more modest absolute gains against placebo. In immunocompromised cohorts, pooled resolution is 75.3% after a single transplant and 87.4% after repeated treatment, with recurrence in 23.9% and serious adverse events in 10.1% — rates comparable with immunocompetent series. The documented transmission events that prompted regulatory action in 2019 and 2020 both occurred in immunocompromised recipients, and one was fatal.nConclusion:The efficacy signal in immunosuppressed patients is consistent and large, and the residual risk is concentrated in donor screening g rather than in the procedure. Screening for multidrug-resistant organisms, a documented consent discussion about transmissible infection, and structured follow-up are what make transplantation defensible in this group.
Abbreviations:CDI – Clostridioides difficile Infection, rCDI – Recurrent CDI, FMT – Faecal Microbiota Transplantation, MDRO –
– Multidrug-Resistant Organism, ESBL – Extended-Spectrum Beta-Lactamase, IBD – Inflammatory Bowel Disease, SAE – Serious Adverse Event.
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