Competitively Selected Donor Fecal Microbiota Transplantation

ABSTRACTIn this prospective cohort study, we examine the feasibility of a protocol to optimize microbiota for fecal microbiota transplantation (FMT). Donor stool metrics generally accepted as markers of gut health were used to select a stool donor based on superior microbial diversity, balanced constitution of Bacteroidetes versus Firmicutes and high concentration of fecal butyrate. Selected donor microbiota was then administered via FMT. A total of 10 patients with median age of 12 years with recurrent Clostridium difficile infection received the intervention. The rate of recurrence‐free resolution with 1‐2 FMTs was 100% at Week 10. With a single FMT, 80% of patients cleared Clostridium difficile infection without recurrence, whereas 20% of patients required a single re‐treatment. No serious adverse events occurred. Microbiota sequencing revealed that recipients’ gut microbiota phylogenic diversity increased by 72‐hours post‐transplantation, with sustainment over 10‐week follow‐up. This study highlights the feasibility of purposefully selecting the most ideal microbiota for transplantation.