A “new” microbiota before transplants

A “new” microbiota before transplants

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Until now, in the clinical setting, fecal transplantation has been mainly applied as a treatment against infections Clostridium difficile, among the most common gastrointestinal infections in hospital settings, where it mainly causes diarrhea, particularly among the elderly. In recent years, however, studies on the possible applications of fecal transplants have exploded, allowing us to imagine their more extensive use. And exceptional cases, like the one followed by the specialists ofMolinette Hospital in Turin (among the “Hospitals of Excellence” for Gastroenterology), confirm that yes, fecal – or intestinal microbiota – transplantation can be used not only to treat diarrhea caused by C.difficile. In this case, in fact, it was performed as a preparatory operation for a liver transplant, to lower the risk of potentially fatal infections in an already severely debilitated person.

A complex case, at risk of incurable infections

To tell all this to Health And Renato Romagnoli, Director of the Liver Transplant Center of Turin who, with his team, performed a liver transplant on a 56-year-old patient with polycystic disease and liver and kidney involvement. “Our patient was an extremely complex case: on dialysis for some time, with portal hypertension, cases of previous infections and significant abdominal bulk.” In fact, the patient’s liver, full of cysts, weighed 15 kg alone. “But not only that: we observed that the intestine was colonized by bacteria resistant to all known antibiotics. And this represented an enormous obstacle to the possibility of a liver transplant: they could in fact have entered the circulation, giving rise to incurable and potentially fatal infections.”

“Resetting the Gut”

Hence the idea of reset the patient’s intestine via fecal transplant, or to use the microbiota to decolonize the recipient’s intestine from multi-resistant bacteria, Romagnoli continues: “In this way it is possible to eradicate multi-resistant germs and prevent critical infections, and thus avoid the risk of a futile liver transplant, i.e. one that does not cure the patient and ‘wastes’ the donation”. In this particular case, however, the Turin center’s experience in fecal transplants was not enough, explains the expert: the abdominal bulk prevented the traditional administration of faeces appropriately prepared via colonoscopy. But not only that: according to what the expert reports, in this way the risk of translocation of resistant bacteria would also have increased. “The only option remained the transplant from “above”: either via a nasogastric tube – but this is also at risk due to possible pneumonia – or, in a much less invasive way, via capsules in which the microbiota is then released into the intestine”.

Microbiota capsules

To create these capsules, the Turin team relied on the experience in the field of the team Antonio Gasbarrinidirector of Internal Medicine and Gastroenterology and of the Center for Digestive System Diseases of the Foundation Agostino Gemelli IRCCS University Hospital of Rome (among the “Hospitals of Excellence” for Gastroenterology). After three months the patient left the hospital and today is at home and fully recovering. “His kidney function has also improved: we know that this will not be the case in the future, but today he can do without dialysis”, concludes Romagnoli.

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