Impact of fecal microbiota transplantation in severe alcoholic hepatitis: A systematic review and meta-analysis

Background and Aim

Severe alcoholic hepatitis (SAH) is a serious condition with few treatments. By modifying the gut–liver axis, fecal microbiota transplantation (FMT) was proposed as a treatment for SAH. The purpose of this meta-analysis was to evaluate the efficacy of FMT versus the standard of care (SOC) in improving SAH patient survival rates.

Methods

A thorough search of electronic databases was conducted till September 2023. The survival rates of SAH patients undergoing FMT versus SOC were compared. Using Review Manager 5.4, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results

The meta-analysis consisted of six studies with a total of 371 patients with SAH. Patients who received FMT had significantly higher survival rates at 1 and 3 months compared to those who received SOC, with pooled OR of 2.91 (95% CI: 1.56–5.42, P = 0.0008) and 3.07 (95% CI: 1.81–5.20, P < 0.0001), respectively. However, the survival advantage disappeared after 6 months (OR: 2.96, 95% CI: 0.99–8.85, P = 0.05) and 1 year of follow-up (OR: 1.81, 95% CI: 0.44–7.46, P = 0.41).

Conclusion

This meta-analysis highlights the potential of FMT to significantly improve short-term survival rates in SAH patients. However, the survival benefit did not last 6–12 months. These findings call for additional research into the effectiveness of FMT over the long term, along with strategies for extending the survival benefit.