PT  - JOURNAL ARTICLE
AU  - Philips, Cyriac Abby
AU  - Phadke, Nikhil
AU  - Ganesan, Karthik
AU  - Augustine, Philip
TI  - Healthy donor faecal transplant for corticosteroid non-responsive severe alcoholic hepatitis
AID  - 10.1136/bcr-2017-222310
DP  - 2017 Nov 08
TA  - BMJ Case Reports
PG  - bcr-2017-222310
VI  - 2017
4099  - http://casereports.bmj.com/content/2017/bcr-2017-222310.short
4100  - http://casereports.bmj.com/content/2017/bcr-2017-222310.full
AB  - Patients with severe alcoholic hepatitis (SAH) have high mortality in the presence of steroid unresponsiveness in the absence of clear treatment recommendations. Liver transplantation is the curative option in such cases but is controversial in the wake of severe infections, post-transplant recidivism and long waiting on deceased donor listing. Animal and human studies have shed light on the beneficial effects of gut microbiota modulation in alcoholic liver disease. We present the first report of faecal microbiota transplantation (FMT) in a steroid non-responder in whom, clinical, biochemical and liver disease severity scores improved post-FMT and demonstrate distinct bacterial population changes pre-FMT and post-FMT. Healthy donor FMT could be safe and efficacious in SAH not responding to corticosteroid treatment, as a bridge to liver transplantation (LT) or in candidates who are unwilling or not ideal for LT for improvement in short-term transplant free survival. Larger controlled studies are required for confirmation.