Towards optimising and standardising donor screening for faecal microbiota transplantion
Gut, vol. 75, pp. 635–645
Abstract
infection or within microbiome intervention clinical trials. Donor screening is of paramount importance given the potential risk of pathogen transmission-a feared complication. While rare in practice, documented cases of FMT-associated infections have resulted in significant morbidity and even mortality. Despite the importance of screening, evidence-based approaches to developing donor-screening protocols are lacking. Inadequate screening for transmissible pathogens may lead to infections in recipients, while overly cautious screening for pathogens with negligible transmission potential could strain healthcare resources and unnecessarily exclude donors, who are already in limited supply. This review aimed to evaluate the evidence underpinning current FMT donor screening protocols. We began by comparing protocols from major FMT guidelines and manufacturers, highlighting their differences in lists of screened pathogens, laboratory assays and clinical characteristics used for donor selection. We critically appraised the existing literature on transmission dynamics for pathogens. These findings were incorporated into a Delphi process with an expert panel group to develop a rational and streamlined screening approach. We further emphasised the importance of maintaining transparency with regard to donor recruitment, screening, monitoring and traceback record keeping. Finally, we explored future directions in donor screening, including approaches to monitoring emerging pathogens and the potential for integration of new technologies, such as metagenomic assays, to enhance and refine donor selection.
Authors 12
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Affiliation as printed
Division of Gastroenterology, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
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King's College London · Guy's and St Thomas' NHS Foundation Trust
Affiliation as printed
Centre for Clinical Infection and Diagnostics Research, Guy’s and St Thomas’ NHS Foundation Trust, King’s College, London, UK
Centre for Clinical Infection and Diagnostics Research, Guy's and St Thomas' NHS Foundation Trust, King's College, London, UK
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University of British Columbia
Affiliation as printed
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Imperial College Healthcare NHS Trust · St Mary's Hospital · Imperial College London
Affiliation as printed
Department of Hepatology and Gastroenterology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
Division of Digestive Diseases, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
Department of Hepatology and Gastroenterology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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King's College London · Guy's and St Thomas' NHS Foundation Trust
Affiliation as printed
Centre for Clinical Infection and Diagnostics Research, Guy’s and St Thomas’ NHS Foundation Trust, King’s College, London, UK
Centre for Clinical Infection and Diagnostics Research, Guy's and St Thomas' NHS Foundation Trust, King's College, London, UK
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Elisabeth M. Terveer Aachen Netherlands Donor Feces Bank and Center for Microbiota Analysis and Therapeutics
Leiden University · Leiden University Medical Center
Affiliation as printed
Netherlands Donor Feces Bank and Center for Microbiota Analysis and Therapeutics, Leiden University Center for Infectious Diseases – Medical Microbiology & Infection Prevention, Leiden University Medical Center, Leiden, Netherlands
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Università Cattolica del Sacro Cuore · Agostino Gemelli University Polyclinic · Istituti di Ricovero e Cura a Carattere Scientifico
Affiliation as printed
Department of Medical and Surgical Sciences, UOC Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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Affiliation as printed
School of Public Health and Tropical Medicine, James Cook University, Townsville City, Queensland, Australia
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Università Cattolica del Sacro Cuore · Agostino Gemelli University Polyclinic · Istituti di Ricovero e Cura a Carattere Scientifico
Affiliation as printed
Department of Medical and Surgical Sciences, UOC CEMAD Centro Malattie dell’Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
Department of Medical and Surgical Sciences, UOC Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy
Department of Medical and Surgical Sciences, UOC CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
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Chinese University of Hong Kong
Affiliation as printed
Microbiota I-Center (MagIC), Department of Medicine and Therapeutics, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Science, Center for Gut Microbiota Research, New Cornerstone Science Laboratory, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Dina H. Kao corresponding Aachen Netherlands Donor Feces Bank and Center for Microbiota Analysis and Therapeutics
Leiden University · University of Alberta · Leiden University Medical Center
Affiliation as printed
Division of Gastroenterology, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
Netherlands Donor Feces Bank and Center for Microbiota Analysis and Therapeutics, Leiden University Center for Infectious Diseases – Medical Microbiology & Infection Prevention, Leiden University Medical Center, Leiden, Netherlands
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Ed J. Kuijper Aachen Netherlands Donor Feces Bank and Center for Microbiota Analysis and Therapeutics
Leiden University · Leiden University Medical Center
Affiliation as printed
Netherlands Donor Feces Bank and Center for Microbiota Analysis and Therapeutics, Leiden University Center for Infectious Diseases – Medical Microbiology & Infection Prevention, Leiden University Medical Center, Leiden, Netherlands
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