Fecal microbiota transplantation with frozen capsules for a patient with refractory acute gut graft-versus-host disease

Abstract

1. Bacterial diversity was restored after FMT with oral frozen capsules, with improvement of diarrhea.

2. Oral FMT for steroid-refractory acute gGVHD is feasible and could be effective.

Figure 1.

Clinical course and microbiota dynamics. The fecal sample that was obtained immediately before the initiation of the first FMT on the same day was analyzed as “pre” data. The time points such as “next week,” “1w,” “2w,” and “4w” indicate periods from the initiation of the first or second cycle of FMT. *rATG was administered at 1 mg/kg on days 99 and 105 after transplantation. †Methylprednisone was administered at 1 g/d for 3 days. ‡CMV antigenemia was detected by C10/11 method until day 110 after transplantation in the previous hospital and C7-horseradish peroxidase assay from day 117 after transplantation. §Only the top 10 genus-level organisms were described; organisms not in the top 10 were classified as “others.” ACV, acyclovir; CFPM, cefepime; CMV, cytomegalovirus; FCN, foscarnet; FLCZ, fluconazole; L-AmB, liposomal amphotericin B; LVFX, levofloxacin; MEPM, meropenem; MCFG, micafungin; mPSL, methylprednisone; PIPC/TAZ, piperacillin/tazobactam; PSL, prednisone; TAC, tacrolimus; VCM, vancomycin; VGCV, valganciclovir; VRCZ, voriconazole; w, week.

Figure 2.

Weighted UniFrac distance analysis. (A) The fecal microbiota dynamics of the patient and the donor. (B) Distance from the donor fecal microbiota of the first FMT. The fecal sample that was obtained immediately before the initiation of the first FMT on the same day was analyzed as “pre” data. The time points such as “next day,” “1w,” “2w,” and “4w” indicate periods from the initiation of the first or second cycle of FMT.