By Maggie Ow | Posted: Saturday February 23, 2019
Dr Maggie Ow reports on the first meeting which took place at the Gastro ASM in November
The first meeting of the NZ working group on faecal microbiota transplantation (FMT) was held recently in Dunedin, during the NZSG conference. The group comprised of six gastroenterologists, two infectious disease specialists, and a gastroenterology nurse specialist. We would like to acknowledge Campbell White for coming up with the suggestion of a national group on FMT, with the main purpose of assisting clinicians in delivering FMT across the country in a safe and standardised model.
There is really only one widely accepted indication for FMT at this point in time, which is refractory or recurrent C. difficile infection, but FMT, certainly anecdotally, has also been performed in NZ for other indications including IBD and IBS. There is no information on which parts of the country are providing FMT; who is delivering it and how; what protocols are in place for screening donors; and how samples are stored (in the case of frozen) and processed. A national survey of NZ gastroenterologists on their experiences with FMT would be most informative and the group will be looking at distributing this later on in the year.
There are a number of areas this group will be working on to provide some direction for clinicians and units looking at incorporating FMT into their clinical practice. We recognise that there are variations in protocols when it comes to delivering FMT and this is a refection of the lack of evidence in this area, making consensus difficult; regardless, the screening of potential donors needs to be performed with great rigour to minimize the risk of transmissible conditons and a robust protocol has to be established. The group is starting work on a draft protocol for donor screening, which will require extensive collaboration with our microbiology colleagues. Any formal protocols will need to be endorsed at a societal level. Finally, strict record keeping and auditing of FMT practices are recommended for quality control, including a database of donors, transplants performed, successes and failures, and complications. This will be one of the areas the group will be working on to provide recommendations.
There was much talk of a stool bank and how best to establish this. Stool banks allow FMT to be more tightly regulated as a practice, and to ensure a high quality of donors and samples is maintained. They should be set up at a regional rather than a national level to allow easy access to donor samples. One of our main goals will be to help facilitate the establishment of regional stool banks to make FMT more widely available across the country.
Dr Maggie Ow