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European consensus conference on faecal microbiota transplantation in clinical practice
  1. Giovanni Cammarota1,
  2. Gianluca Ianiro1,
  3. Herbert Tilg2,
  4. Mirjana Rajilić-Stojanović3,
  5. Patrizia Kump4,
  6. Reetta Satokari5,
  7. Harry Sokol6,
  8. Perttu Arkkila7,
  9. Cristina Pintus8,
  10. Ailsa Hart9,
  11. Jonathan Segal9,
  12. Marina Aloi10,
  13. Luca Masucci11,
  14. Antonio Molinaro12,
  15. Franco Scaldaferri1,
  16. Giovanni Gasbarrini1,
  17. Antonio Lopez-Sanroman13,
  18. Alexander Link14,
  19. Pieter de Groot15,
  20. Willem M de Vos5,16,
  21. Christoph Högenauer4,
  22. Peter Malfertheiner14,
  23. Eero Mattila17,
  24. Tomica Milosavljević18,
  25. Max Nieuwdorp12,15,19,
  26. Maurizio Sanguinetti11,
  27. Magnus Simren20,
  28. Antonio Gasbarrini1
  29. The European FMT Working Group
  1. 1Department of Gastroenterological Area, “A. Gemelli” Hospital, Catholic University of the Sacred Heart, Rome, Italy
  2. 2Department of Internal Medicine I, Gastroenterology, Endocrinology & Metabolism, Medical University, Innsbruck, Austria
  3. 3Faculty of Technology and Metallurgy, Department of Biochemical Engineering and Biotechnology, University of Belgrade, Belgrade, Serbia
  4. 4Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University, Graz, Austria
  5. 5Faculty of Medicine, Immunobiology Research Program, Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland
  6. 6Gastroenterology and Nutrition Department, AP-HP, French Group of Faecal Microbiota Transplantation (GFTF), Saint-Antoine Hospital and UPMC Paris 06, Paris, France
  7. 7Department of Clinic of Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  8. 8Tissues and Cells Area, Italian National Transplant Center (CNT), Rome, Italy
  9. 9Department of Gastroenterology, St. Mark's Hospital, London, UK
  10. 10Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University, Rome, Italy
  11. 11Laboratory of Microbiology, “A. Gemelli” Hospital, Catholic University of the Sacred Heart, Rome, Italy
  12. 12Department of Molecular and Clinical Medicine, Wallenberg Laboratory, University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
  13. 13Gastroenterology and Hepatology Service, Ramón y Cajal University Hospital, Madrid, Spain
  14. 14Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Hospital, Magdeburg, Germany
  15. 15Department of Internal Medicine, Academic University Medical Center, Amsterdam, The Netherlands
  16. 16Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands
  17. 17Department of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland
  18. 18Clinic for Gastroenterology and Hepatology, University of Belgrade and School of Medicine, Clinical Center of Serbia, Belgrade, Serbia
  19. 19Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
  20. 20Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
  1. Correspondence to Professor G Cammarota, Gastroenterological Area, Fondazione Policlinico Universitario Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Rome 00168, Italy; giovanni.cammarota{at}unicatt.it

Abstract

Faecal microbiota transplantation (FMT) is an important therapeutic option for Clostridium difficile infection. Promising findings suggest that FMT may play a role also in the management of other disorders associated with the alteration of gut microbiota. Although the health community is assessing FMT with renewed interest and patients are becoming more aware, there are technical and logistical issues in establishing such a non-standardised treatment into the clinical practice with safety and proper governance. In view of this, an evidence-based recommendation is needed to drive the practical implementation of FMT. In this European Consensus Conference, 28 experts from 10 countries collaborated, in separate working groups and through an evidence-based process, to provide statements on the following key issues: FMT indications; donor selection; preparation of faecal material; clinical management and faecal delivery and basic requirements for implementing an FMT centre. Statements developed by each working group were evaluated and voted by all members, first through an electronic Delphi process, and then in a plenary consensus conference. The recommendations were released according to best available evidence, in order to act as guidance for physicians who plan to implement FMT, aiming at supporting the broad availability of the procedure, discussing other issues relevant to FMT and promoting future clinical research in the area of gut microbiota manipulation. This consensus report strongly recommends the implementation of FMT centres for the treatment of C. difficile infection as well as traces the guidelines of technicality, regulatory, administrative and laboratory requirements.

  • DIARRHOEAL DISEASE
  • ENTERIC BACTERIAL MICROFLORA
  • CLINICAL DECISION MAKING

This is an Open Access article 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: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Twitter Follow Gianluca Ianiro @gianluca1aniro

  • Contributors GC, GI and AG planned the meeting and established the main topics. All panel members were involved in developing the statements with supporting evidence and drafted the text of discussion relevant to their statements. GC wrote the initial draft of the manuscript. All panel faculties read and revised the manuscript for important intellectual content and approved the final manuscript.

  • Funding MN is supported by a ZONMW-VIDI grant 2013 (016.146.327) and CVON by a Young Talent grant 2012. RS is supported by Academy of Finland (258439).

  • Competing interests MN is in the scientific advisory board of Seres Therapeuticals and Caelus Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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  • PostScript
    E M Terveer Y H van Beurden A Goorhuis C J J Mulder E J Kuijper J J Keller On behalf of the Working Group of The Netherlands Donor Feces Bank HW Verspaget MP Bauer CMJE Vandenbroucke-Grauls MGW Dijkgraaf E van Nood J Seegers