Australian consensus statements for the regulation, production and use of faecal microbiota transplantation in clinical practice.

2020-04-03

Haifer, Craig

Kelly, Colleen R

Paramsothy, Sudarshan

Andresen, David

Papanicolas, Lito E

McKew, Genevieve L

Borody, Thomas J

Kamm, Michael

Costello, Samuel P

Andrews, Jane M

Begun, Jakob

Chan, Hiu Tat

Connor, Susan

Ghaly, Simon

Johnson, Paul D R

Lemberg, Daniel A

Paramsothy, Ramesh

Redmond, Andrew

Sheorey, Harsha

van der Poorten, David

Leong, Rupert W

Clostridioides difficile

FMT

faecal microbiota transplantation

inflammatory bowel disease

microbiome therapeutics

stool bank

Journal Article

0000-0002-3675-6550

0000-0002-9097-6028

0000-0002-5838-7274

0000-0002-5238-9260

0000-0002-0519-4698

0000-0002-2857-1812

0000-0001-5256-7672

0000-0001-5606-0270

0000-0003-2489-6430

0000-0002-1125-5362

0000-0001-5944-3488

0000-0001-9873-7163

10.1136/gutjnl-2019-320260

Faecal microbiota transplantation (FMT) has proved to be an extremely effective treatment for recurrent Clostridioides difficile infection, and there is interest in its potential application in other gastrointestinal and systemic diseases. However, the recent death and episode of septicaemia following FMT highlights the need for further appraisal and guidelines on donor evaluation, production standards, treatment facilities and acceptable clinical indications. For these consensus statements, a 24-member multidisciplinary working group voted online and then convened in-person, using a modified Delphi approach to formulate and refine a series of recommendations based on best evidence and expert opinion. Invitations to participate were directed to Australian experts, with an international delegate assisting the development. The following issues regarding the use of FMT in clinical practice were addressed: donor selection and screening, clinical indications, requirements of FMT centres and future directions. Evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Consensus was reached on 27 statements to provide guidance on best practice in FMT. These include: (1) minimum standards for donor screening with recommended clinical selection criteria, blood and stool testing; (2) accepted routes of administration; (3) clinical indications; (4) minimum standards for FMT production and requirements for treatment facilities acknowledging distinction between single-site centres (eg, hospital-based) and stool banks; and (5) recommendations on future research and product development. These FMT consensus statements provide comprehensive recommendations around the production and use of FMT in clinical practice with relevance to clinicians, researchers and policy makers.

link

Gut 2020; 69(5): 801-810

Gut