Fecal microbiota transplantation in clinical practice: Present controversies and future prospects

The gut microbiota, serving as the only “organ” that humans can share, has been extensively applied in the treatment of various intestinal and extraintestinal diseases through fecal microbiota transplantation (FMT) technology. By optimizing the donor selection strategy, FMT exhibited the highest effectiveness (more than 90%) in treating acute intestinal inflammations, such as recurrent Clostridium difficile infection. However, the efficacy diminishes when addressing intestinal functional diseases (more than 60%), chronic intestinal inflammations or organic diseases (less than 60%), and extraintestinal diseases, particularly those lacking any gastrointestinal symptoms (less than 50%). Ongoing efforts to enhance the therapeutic response of FMT across diverse diseases represent a central focus of current clinical research. This review concentrates on donor selection, recipient management, precise donor-recipient matching, antagonistic mechanism of native bacteria to transplanted bacteria, and targeted treatment strategies for different diseases, with the aim of providing practical strategies to improve the clinical efficacy of FMT.