International consensus conference on stool banking for faecal microbiota transplantation in clinical practice

Giovanni Cammarota, Gianluca Ianiro, Colleen R Kelly, Benjamin H Mullish, Jessica R Allegretti, Zain Kassam, Lorenza Putignani, Monika Fischer, Josbert J Keller, Samuel Paul Costello, Harry Sokol, Patrizia Kump, Reetta Satokari, Stacy A Kahn, Dina Kao, Perttu Arkkila, Ed J Kuijper, Maria J Gt Vehreschild, Cristina Pintus, Loris Lopetuso, Luca Masucci, Franco Scaldaferri, E M Terveer, Max Nieuwdorp, Antonio López-Sanromán, Juozas Kupcinskas, Ailsa Hart, Herbert Tilg, Antonio Gasbarrini, Giovanni Cammarota, Gianluca Ianiro, Colleen R Kelly, Benjamin H Mullish, Jessica R Allegretti, Zain Kassam, Lorenza Putignani, Monika Fischer, Josbert J Keller, Samuel Paul Costello, Harry Sokol, Patrizia Kump, Reetta Satokari, Stacy A Kahn, Dina Kao, Perttu Arkkila, Ed J Kuijper, Maria J Gt Vehreschild, Cristina Pintus, Loris Lopetuso, Luca Masucci, Franco Scaldaferri, E M Terveer, Max Nieuwdorp, Antonio López-Sanromán, Juozas Kupcinskas, Ailsa Hart, Herbert Tilg, Antonio Gasbarrini

Abstract

Although faecal microbiota transplantation (FMT) has a well-established role in the treatment of recurrent Clostridioides difficile infection (CDI), its widespread dissemination is limited by several obstacles, including lack of dedicated centres, difficulties with donor recruitment and complexities related to regulation and safety monitoring. Given the considerable burden of CDI on global healthcare systems, FMT should be widely available to most centres.Stool banks may guarantee reliable, timely and equitable access to FMT for patients and a traceable workflow that ensures safety and quality of procedures. In this consensus project, FMT experts from Europe, North America and Australia gathered and released statements on the following issues related to the stool banking: general principles, objectives and organisation of the stool bank; selection and screening of donors; collection, preparation and storage of faeces; services and clients; registries, monitoring of outcomes and ethical issues; and the evolving role of FMT in clinical practice,Consensus on each statement was achieved through a Delphi process and then in a plenary face-to-face meeting. For each key issue, the best available evidence was assessed, with the aim of providing guidance for the development of stool banks in order to promote accessibility to FMT in clinical practice.

Keywords: clostridioides difficile; fecal microbiota transplantation; guideline; microbiota; stool bank.

Conflict of interest statement

Competing interests: JRA received grants from, and consulted for, Finch Therapeutics and Merck and Co. GC, GI, FS and LM received grants in the field of faecal microbiota transplantation (FMT) from the Italian Ministry of Health. SPC received fees from Shire, Ferring, Microbiotica, Pfizer and Janssen. MF is consultant to Finch Therapeutics Group and DSMB member for Rebiotix. AH has served as consultant, advisory board member or speaker for AbbVie, Atlantic, Bristol-Myers Squibb, Celltrion, Falk, Ferring, Janssen, MSD, Napp Pharmaceuticals, Pfizer, Pharmacosmos, Shire and Takeda; she also serves on the Global Steering Committee for Genentech. ZK is an employee/shareholder at Finch Therapeutics and advisor/consultant at OpenBiome. JK and EJK received research grants from Vedanta Bioscences, Boston, USA. CPK is a clinical site for the PRISM FMT trial conducted by Finch Therapeutics. HS received unrestricted study grants: Danone, Biocodex, Enterome; board membership, consultancy or lecture fees: Carenity, Abbvie, Astellas, Danone, Ferring, Mayoly Spindler, MSD, Novartis, Roche, Tillots, Enterome, Maat, BiomX, Biose, Novartis, Takeda; co-funder of Exeliom Biosciences. All the remaining authors have nothing to declare.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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