Fecal Microbial Transplantation in Severe Alcoholic Hepatitis

Fecal Microbial Transplantation for Corticosteroids Non-responders and Non-eligible Patients With Severe Alcoholic Hepatitis

1. A subtype of Alcoholic hepatitis (AH), named severe alcoholic hepatitis (SAH) is associated with high short-term mortality (J Hepatol, 2019)
2. The only SAH treatment option - corticosteroids (CS) - are often contraindicated or ineffective (STOPAH Trial)
3. New treatment modalities for remaining patients are much needed
4. Fecal microbial transplantation (FMT) is one of the promising therapies
5. Investigators aimed to see if FMT improves survival in patients admitted with SAH, not responding to-, or non-eligible for CS.

• FMT via upper GI tract is provided to CS non-responders (NR) or non-eligible (NE) adult patients hospitalized with SAH (determined by the Lille-model).
• Modified version of the Sarin FMT protocol is used with microbiota material procured from unrelated healthy donors.

Inclusion Criteria:

• consenting, adult
• severe form of acute alcoholic hepatitis (SAH)
• non-responder to corticosteroids according to the Lille model
• patients with SAH not eligible for corticosteroids based on their contraindications

Exclusion Criteria:

• active infection
• presence of untreated large / high-risk / bleeding esophageal varices
• too sick for any therapy / futility (chronic extrahepatic organ failures, no potential for recovery, etc)
• malignancy except for hepatocellular carcinoma in Milan criteria