COMMENTARY

Microbiome Makeover: Out With the Bad, In With the Good?

Digestive Disease Week (DDW) 2018

William F. Balistreri, MD

Disclosures

August 08, 2018

In This Article

A Donor Effect?

Whereas a stool donor effect has been reported in FMT for patients with active UC, there is no evidence to suggest that donor features determine clinical cure in patients with CDI. Through standardized donor selection and quality assurance monitoring, stool banks are uniquely positioned to monitor apparent variations in efficacy across a large pool of donors.

Osman and colleagues[11] used this approach to analyze patient and donor microbiome characteristics and evaluate factors driving apparent variations in donor efficacy. CDI disease type (eg, recurrent, refractory), FMT delivery modality, and healthcare provider and physician-reported clinical outcomes were collected from healthcare facilities. Data at the patient level were linked to a stool donor. 16S rRNA sequencing was used to determine donor stool microbial profiles. The investigators reported that donor factors (donor microbial community or microbial profile) did not affect clinical outcomes of FMT in the treatment of recurrent CDI. Recipient factors and clinical practice, including an appropriate diagnosis of CDI, probably determine the clinical response.

Bottom line—the ideal composition of the "transplant" will depend on several host and donor characteristics.

What Would Motivate Someone to Be a Donor?

To develop an effective FMT program, stool donors are essential; however, recruitment and retention are challenging.

McSweeney and colleagues[12] aimed to identify factors that could optimize their donor program and improve donor retention. A 32-item questionnaire was completed by 802 donors; about 42% indicated altruism as the main reason that they volunteered to become a stool donor, and economic compensation was an additional motivator in 35%. The screening process, high frequency of stool donation, and logistics of collecting/transporting stools were cited as potential deterrents. These variables should be taken into consideration when recruiting and retaining stool donors.

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