Failure of Fecal Microbiota Transplantation in a Three-Year-Old Child with Severe Refractory Ulcerative Colitis

Abstract

Fecal microbiota transplantation (FMT) is a treatment designed to correct gut dysbiosis by administration of feces from a healthy volunteer. It is still unclear whether FMT for children with ulcerative colitis (UC) is effective or hazardous. Here we describe a young patient to have received FMT for UC. A three-year-old girl was admitted to our hospital with severe active UC, and treated with aminosalicylates and various immunosuppressive drugs. As remission was not achieved, we decided to try FMT before colectomy. We administered donor fecal material a total of six times by retention enema (×2) and via a nasoduodenal tube (×4) within 10 days. The patient developed abdominal pain and pyrexia after each FMT session. Analyses revealed the transferred donor fecal microbiota had not been retained by the patient, who ultimately underwent colectomy. The severity of the UC and/or timing of FMT may have partly accounted for the poor outcome.

Keywords: Colectomy; Fecal microbiota transplantation; Gastrointestinal microbiome; Inflammatory bowel diseases; Pediatric ulcerative colitis.

Figures

Fig. 1. (A) Colonoscopy demonstrates severe diffuse and continuous mucosal inflammation with superficial ulcers and erythema. (B) Low-power view of histological features in the colonic biopsy specimen compatible with ulcerative colitis, including active inflammation with cryptitis (hematoxylin and eosin [H&E] stain, ×100). (C) Gross appearance of a colectomy specimen, demonstrating diffuse and continuous severe mucosal inflammation and ulcerations with a partial pseudo-polyp-like appearance. (D) Medium-power view of a section of the colon, demonstrating severe active inflammation with loss of crypts and epithelium (H&E stain, ×200).

Fig. 2. Fecal microbiota composition of the donor and recipient measured by T-RFLP (A, T-RF area ratio digested by HhaI; B, T-RF area ratio digested by MspI). The patient underwent probiotic therapy with Clostridium butyricum throughout the treatment until colectomy. The graphs demonstrate that the patient did not show a coherent microbiota composition compared to the healthy donor before treatment. After fecal microbiota transplantation (FMT), the patient's fecal microbiota composition was quite different from that of the donor. Thus, the transferred donor fecal microbiota was not retained in the patient's gut. T-RF: terminal restriction fragments, T-RFLP: T-RF length polymorphism.