Fecal microbiota transplantation in compassionate indications: French experience from 2019 to 2022 - 14/02/26

Doi : 10.1016/j.idnow.2026.105247

Paul Nicolas Vullierme ^a, Tatiana Galperine ^b,^c, Nicolas Benech ^b,^d,^e,^f, Laurent Alric ^b,^g,^h, Alexis Mosca ^b,ⁱ, Anne-Christine Joly ^b,^j,^k,^l, Nathalie Kapel ^b,^j,^l,^m,ⁿ, Julien Scanzi ^b,^o,^p, Cecilia Landman ^b,^j,^l,^q, Harry Sokol ^b,^j,^l,^q, Alexandre Bleibtreu ^b,^j,^l,^r,^⁎

^a Service des Maladies infectieuses et Tropicales, Hôpital Pitié Salpêtrière, APHP Sorbonne Université, Paris, France

^b Groupe Français de Transplantation Fécale (GFTF), France

^c Service Des Maladies Infectieuses, Centre Hospitalier Universitaire Vaudois, Lausanne, Suisse, UK

^d Service d’Hépato-Gastroentérologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France

^e Groupe d’étude du microbiote (GEM), Lyon, France

^f CRCL, Université Claude Bernard Lyon 1, Lyon, France

^g Service de Médecine Interne et Gastrologie, Hôpital Rangueil, Université Toulouse 3, France

^h Service de Gastroentérologie et Nutrition Pédiatriques, Hôpital Robert-Debré, APHP, Paris, France

ⁱ Centre de transplantation fécale de l’AP-HP, Paris, France

^j Unité de Préparation Des Transplants de Microbiote (UPTM), Hôpital Saint-Antoine, APHP Sorbonne Université Paris, France

^k Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France

^l Laboratoire de Coprologie, APHP, GH Pitié-Salpêtrière, Paris, France

^m INSERM S1139, Faculté de Pharmacie, Université Paris Cité, Paris, France

ⁿ Service d’Hépato-Gastroentérologie, Centre Hospitalier de Thiers, Thiers, France

^o Service d’Hépato-Gastroentérologie, CHU de Clermont Ferrand, Clermont Ferrand, France

^p Service de Gastroentérologie, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint-Antoine Hospital, Sorbonne Université, Paris, France

^q INRAE, AgroParisTech, Micalis Institute, Université Paris-Saclay, Jouy-en-Josas, France

^r INSERM U 1135, Cimi-Paris, Paris, France

^⁎ Corresponding author.

Highlights

•	Validated for recurrent Clostridioides difficile infections (rCDI), fecal microbiota transplantation (FMT) is now proposed for new indications, but no trial has definitively validated the place of FMT in these compassionate indications.
•	New indications are eradication of multidrug-resistant organisms (MDROs), digestive tract graft-versus-host disease (GVHD), inflammatory bowel diseases (IBD), and prevention of recurrent infections.
•	The French National Commission (NC) was created in 2019 to address requests for compassionate FMT (cFMT). The NC reviewed 67 cases in four years and confirmed the indication for 54 cases during the period 2019–2022.
•	The two main indications were severe GVHD and MDRO carriage eradication with a success rate of 53% and 31%, respectively.
•	The most relevant compassionate indication seems to be corticosteroid-resistant GVHD with an impact on mortality due to disease severity.

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Abstract

Background

Fecal microbiota transplantation (FMT) is validated for recurrent Clostridioides difficile infections but is increasingly considered for compassionate indications: steroid-refractory graft-versus-host disease (GVHD), multidrug-resistant organism (MDRO) eradication, severe inflammatory or infectious colitis. Evidence remains limited outside clinical trials.

Methods

Retrospective multicenter analysis of requests submitted to the French National Commission for compassionate FMT between 2019 and 2022. Approved cases were evaluated for feasibility, safety, and clinical outcomes.

Results

Among 67 requests, 54 were approved and 40 FMT procedures were performed. The main indications were severe steroid-resistant GVHD (35%), MDRO carriage (28%), and inflammatory/infectious colitis (12%). Overall success was 37.5%. The response rate for GVHD was 53% and 31% for MDRO eradication. Adverse events were mostly mild.

Conclusions

Compassionate FMT in France is feasible through a centralized process but shows variable efficacy depending on the indication. GVHD seems to be the most promising target, while MDRO eradication and colitis require further evaluation.

Le texte complet de cet article est disponible en PDF.

Keywords : Fecal microbiota transplantation, BMR eradication, Digestive graft versus host disease

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Vol 56 - N° 2

Article 105247- février 2026 Retour au numéro

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Fecal microbiota transplantation in compassionate indications: French experience from 2019 to 2022 - 14/02/26

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