Assessment of fecal microbiota transplantation as add on therapy in management of severe alcoholic hepatitis at tertiary care centre in North India

Abstract

Background and aim: Severe alcoholic hepatitis (SAH) demands definitive management therapy with long term survival benefit. As alcohol induced intestinal dysbiosis is central to the development of SAH, there is an intense effort in recent past to explore the therapeutic potential of modulating gut microbiota. With this background, the current study was performed to assess whether, the inclusion of Fecal Microbiota Transplantation (FMT) with current Standard of Care (SOC) in steroids eligible SAH patients, leads to any survival benefit and/ or improvement in various prognostic scores. Methods: In this randomized prospective study, group A had 10 patients of SAH who were provided standard of care (SOC) and 10 in group B were imparted Fecal Microbiota Transplantation (FMT) along with SOC. Survival and prognostic scores viz. Child Pugh Turcotte (CTP), Model for End Stage Liver Disease (MELD), MELD sodium (MELD Na), Glasgow Alcoholic Hepatitis score (GAHS) and Maddrey's Discriminant Function (mDF) were evaluated at 1 and 3 months. Overall survival at 6 months was assessed. Results: Overall, 11(55%) patients were steroid- responsive (Lille score>0.45); 6 of group A and 5 of group B. At baseline, mean serum protein was significantly higher in group A (6.58±0.57gm/dL) than group B (5.94±0.55gm/dL). Group B had significantly higher leucocyte count, urea level and GAHS at 1st (8.67±0.5) and 3rd (6.67±0.58) month. Mortality was similar (20%) at 1 month, 70% in group B and 50% in group A at 3 months. At 6 months, mortality was significantly higher in group B (90%) than A (70%) (p=0.007). Conclusion: No survival benefits seen with addition of FMT to SOC in SAH. Significant higher leucocyte count at 1st and 3rd month and higher mortality at 6 months was observed after addition of FMT which might point towards the propensity to cause sepsis.