S1240 Investigation of the Benefit of Fecal Microbiota Transplantation in Prevention of Hepatic Encephalopathy in Patients With Decompensated Liver Cirrhosis: A Systematic Review and Meta-Analysis of Clinical Trials

Abstract

Introduction: Patients with decompensated liver cirrhosis are at risk of developing hepatic encephalopathy (HE).The current standard of care (SOC) in HE consists of correcting precipitating factors, nutritional support, and the use of lactulose and rifaximin. Lactulose and rifaximin are thought to alter gut flora thereby reducing ammonia production. Recent studies have investigated the benefit of fecal microbiota transplantation (FMT) in preventing HE in patients with liver cirrhosis. We performed a systematic review and meta-analysis to evaluate the benefit of FMT versus SOC in preventing HE and various outcomes in patients with decompensated liver cirrhosis. Methods: A literature search was performed using Scopus, PubMed/MEDLINE, and Cochrane databases from inception to June 2021. Studies included in our meta-analysis involved adult patients diagnosed with decompensated liver cirrhosis who received prophylactic FMT versus standard of care (SOC). Analysis was conducted using the Mantel-Haenszel model to assess the rate of HE, severe adverse events (SAE), death, variceal bleeding, and infection risk. The results were pooled together using Reviewer Manager 5.4 software, and heterogeneity was quantified using I2 statistics. Results: Five clinical trials involving 129 patients were included in the final analysis. All studies but one were randomized controlled trials. Our findings suggest that FMT provides a significant benefit in preventing HE in patients with decompensated liver cirrhosis (OR 0.12, 95% CI [0.02, 0.58], P=0.009) compared to SOC. The rate of severe adverse events was significantly lower in the FMT group (OR 0.07, P< 0.0001). The rates of death (OR 0.33, P=0.05), variceal bleeding (OR 0.51, P=0.30), and infection (OR 1.01, P=0.98) was similar between both groups. Only one study investigated the rate of spontaneous bacterial peritonitis, as a result, analysis was not performed for this outcome. Conclusion: Prophylactic use of fecal microbiota transplantation demonstrated a significant benefit in preventing hepatic encephalopathy and serious adverse events in patients with decompensated liver cirrhosis as compared to standard of care. There were no differences noted in terms of death rate, variceal bleeding, or the incidence of infection. The major limitation of this systematic review is the scarcity of studies about this topic and the small sample size of the analyzed studies.Figure 1.: Multivariate analysis for risk factors for NAFLDTable 1.: Clinical characteristics of the study population