Philips Cyriac Abby, Phadke Nikhil, Ganesan Karthik, Augustine Philip
The Liver Unit, Ernakulam Medical Centre, Kochi, Kerala, India.
Molecular, Cellular and Developmental Biology, Genepath Dx, Pune, Maharashtra, India.
BMJ Case Rep. 2017 Nov 8;2017:bcr-2017-222310. doi: 10.1136/bcr-2017-222310.
Patients with severe alcoholic hepatitis (SAH) have high mortality in the presence of steroid unresponsiveness in the absence of clear treatment recommendations. Liver transplantation is the curative option in such cases but is controversial in the wake of severe infections, post-transplant recidivism and long waiting on deceased donor listing. Animal and human studies have shed light on the beneficial effects of gut microbiota modulation in alcoholic liver disease. We present the first report of faecal microbiota transplantation (FMT) in a steroid non-responder in whom, clinical, biochemical and liver disease severity scores improved post-FMT and demonstrate distinct bacterial population changes pre-FMT and post-FMT. Healthy donor FMT could be safe and efficacious in SAH not responding to corticosteroid treatment, as a bridge to liver transplantation (LT) or in candidates who are unwilling or not ideal for LT for improvement in short-term transplant free survival. Larger controlled studies are required for confirmation.
在缺乏明确治疗建议的情况下，重症酒精性肝炎（SAH）患者在对类固醇无反应时死亡率很高。肝移植是此类病例的治愈选择，但在严重感染、移植后复发以及在已故供体名单上长时间等待的情况下存在争议。动物和人体研究揭示了肠道微生物群调节在酒精性肝病中的有益作用。我们首次报告了粪便微生物群移植（FMT）用于一名对类固醇无反应的患者，该患者在FMT后临床、生化指标及肝病严重程度评分均有所改善，并展示了FMT前后不同的细菌种群变化。健康供体FMT对于对皮质类固醇治疗无反应的SAH患者可能是安全有效的，可作为肝移植（LT）的桥梁，或用于那些不愿意接受LT或不适合LT的患者，以改善短期无移植生存期。需要更大规模的对照研究来证实这一点。
