Tariq Raseen, Weatherly Renee, Kammer Patricia, Pardi Darrell S, Khanna Sahil
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
J Clin Gastroenterol. 2018 Feb;52(2):146-150. doi: 10.1097/MCG.0000000000000768.
To evaluate our experience with stool donor recruitment, screening, retention, and donor perception for fecal microbiota transplantation (FMT).
Multiply recurrent Clostridium difficile infection is being increasingly managed with FMT from donor stools. However, donor selection and recruitment is challenging due to lack of standard evidence-based guidelines, donor exclusion criteria, frequency of screening and donor commitment.
Data on donors screened using institutional guidelines with history, blood and stool testing and their perspectives on donation were analyzed.
Overall 42 potential donors (21 known and 21 standard) were prescreened. Of known donors (median age 34 y, 66.6% female), none failed prescreening, blood or stool tests. Twelve standard donors (57%) failed prescreening based on history (depression, diarrhea, autoimmune disease, recent antibiotic exposure, colon polyps, pregnancy). Nine (median age 35 y, 44.4% female) passed blood and stool testing. On repeat screening, 3 were excluded (2-positive stool shiga toxin (asymptomatic), 1-pregnancy). One donor opted out and 5 became long-term donors; 3 have donated >50 times and 2 have donated >25 times. On the basis of donor perception questionnaire, most standard donors were aware of FMT for C. difficile infection as a treatment option and would not consider 3-monthly blood and stool testing inconvenient.
A significant proportion of healthy individuals who volunteered to become a standard donor failed prescreening and were not subjected to blood and stool testing. Repeat testing for asymptomatic donors may be a barrier to donor retention. Universal guidelines are needed to develop strategies to facilitate donor screening.
评估我们在粪便供体招募、筛查、留存以及供体对粪便微生物群移植（FMT）认知方面的经验。
复发性艰难梭菌感染越来越多地通过来自供体粪便的FMT进行治疗。然而，由于缺乏基于证据的标准指南、供体排除标准、筛查频率和供体承诺，供体选择和招募具有挑战性。
分析了使用机构指南对供体进行病史、血液和粪便检测的数据以及他们对捐赠的看法。
共对42名潜在供体（21名已知供体和21名标准供体）进行了预筛查。在已知供体中（中位年龄34岁，66.6%为女性），无人在预筛查、血液或粪便检测中不合格。12名标准供体（57%）因病史（抑郁症、腹泻、自身免疫性疾病、近期抗生素暴露、结肠息肉、怀孕）在预筛查中不合格。9名（中位年龄35岁，44.4%为女性）通过了血液和粪便检测。在重复筛查中，3人被排除（2人粪便志贺毒素呈阳性（无症状），1人怀孕）。1名供体退出，5名成为长期供体；3人捐赠超过50次，2人捐赠超过25次。根据供体认知问卷，大多数标准供体知道FMT可作为艰难梭菌感染的一种治疗选择，并且不会认为每三个月进行一次血液和粪便检测不方便。
很大一部分自愿成为标准供体的健康个体在预筛查中不合格，未接受血液和粪便检测。对无症状供体进行重复检测可能是供体留存的一个障碍。需要通用指南来制定促进供体筛查的策略。
