The 6 Ds of Fecal Microbiota Transplantation: A Primer from Decision to Discharge and Beyond

A practical handbook on fecal microbiota transplantation (FMT) for physicians, nurses, physician assistants, students, residents, and fellows, The 6 Ds of Fecal Microbiota Transplantation: A Primer from Decision to Discharge and Beyond provides a clinical framework to understand and administer this treatment as safely and effectively as possible.

FMT has emerged as a promising treatment for C. difficile infection (CDI), and there is a major need for educational resources on the topic. Drs. Jessica Allegretti, Zain Kassam, and their expert contributors are leaders in the field and have collectively cared for thousands of patients suffering from recurrent CDI who have benefitted from FMT.

This guide provides practical tools, clinical pearls, and answers to frequently asked questions. Beginning with introductory information on the microbiome and exploring the history of FMT, The 6 Ds of Fecal Microbiota Transplantation outlines a step-by-step checklist for administering FMT:

• Decision: Who is the right CDI patient to receive FMT? What clinical questions should you ask patients in your FMT clinical assessment?
• Donor: How do you select and screen a donor for FMT?
• Discussion: What are the risks, benefits, and alternatives that need to be discussed with patients?
• Delivery: What is the best delivery method for FMT—colonoscopy, nasogastric tube, enema, or capsules?
• Discharge and follow-up: What is the ideal post-FMT care? How should you council patients following FMT?
• Discovery: What are the most promising emerging clinical applications for FMT? What is the evidence for FMT in obesity, autism, irritable bowel syndrome, inflammatory bowel disease, antibiotic resistant bacteria, and liver disease?

Arming healthcare professionals with the ability to answer questions from patients regarding FMT and the microbiome, The 6 Ds of Fecal Microbiota Transplantation provides a pragmatic guide for this exciting treatment.

Contents

Dedication
Acknowledgments
About the Editors
Contributing Authors

Chapter 1 Introduction
Jessica R. Allegretti, MD, MPH and  Zain Kassam, MD, MPH

Chapter 2 Microbiome 101
Suzanne Devkota, PhD

Chapter 3     The History of Fecal Microbiota Transplantation
Joann Kwah, MD, FACG and Lawrence J. Brandt, MD, MACG, AGAF, FASGE

Chapter 4     Decision: Which Patients With Clostridioides difficile Infection Are Appropriate for Fecal Microbiota Transplantation?
Abbas Rupawala, MD and Colleen R. Kelly, MD

Chapter 5 Decision: Considerations for Use of Fecal Microbiota Transplantation in Special Patient Populations
Rohma Ghani, MBBS, MRCP and Benjamin H. Mullish, MB, BChir, MRCP, PhD

Chapter 6     Donor: How Do You Select and Screen Candidate Donors for Fecal Microbiota Transplantation?
Shrish Budree, MBChB, DCH, FCPaeds, Cert. Paeds Gastro.

Chapter 7     Discussion: How Do You Discuss the Risks and Benefits of Fecal Microbiota Transplantation?
Majdi Osman, MD, MPH and Pratik Panchal, MD, MPH

Chapter 8 Delivery: How Do You Select the Most Appropriate Delivery Modality for Fecal Microbiota Transplantation?
Paul Feuerstadt, MD, FACG, AGAF and Neil Stollman, MD, FACP, FACG, AGAF

Chapter 9     Discharge: How Should You Follow and Care for Patients After Fecal Microbiota Transplantation?
Lauren Tal Grinspan, MD, PhD and Ari M. Grinspan, MD

Chapter 10 Discovery: Emerging Indications
Jessica R. Allegretti, MD, MPH and Zain Kassam, MD, MPH
Chapter 11 Frequently Asked Questions
Jessica R. Allegretti, MD, MPH and Zain Kassam, MD, MPH

Financial Disclosures
Index

Reviews

The book provides very detailed descriptions of the existing evidence along with impressive references, acknowledges unanswered questions, and gives good direction . . . it contains a wealth of information.

© Doody’s Review Service, 2021, Alla Grigorian, MD(University of Kentucky College of Medicine)

About the Editors

Jessica R. Allegretti, MD, MPH serves as the Associate Director of the Crohn’s and Colitis Center at Brigham and Women’s Hospital, Boston, Massachusetts, where she built and leads the Clinical Trials Program. She also founded the hospital’s Fecal Microbiota Transplantation Program and continues to serve as the program’s Director. 

Dr. Allegretti is a gastroenterologist and physician-scientist dedicated to discovering and developing innovative microbiome therapeutics and novel treatments for inflammatory bowel disease. She was awarded the IBD Rising Star Award by the New Chapter of the Crohn’s and Colitis Foundation her first year on staff. She serves on the Scientific Advisory Board for OpenBiome, the largest not-for-profit stool bank, and is the Clinical Development Lead for the Massachusetts-Host Microbiome Center. She has authored more than 100 abstracts and peer-reviewed publications in leading journals such as the New England Journal of Medicine, The Lancet, and Gastroenterology, and was recently appointed as an Associate Editor for the Inflammatory Bowel Diseases Journal.  

Dr. Allegretti has led multiple prospective microbiome therapeutic studies, including the first trials in primary sclerosing cholangitis and obesity. She has received funding from the National Institutes of Health, the American College of Gastroenterology, and the Crohn’s and Colitis Foundation. Dr. Allegretti has been featured on HBO, BBC, Netflix, the New York Times and numerous other media outlets. 

Dr. Allegretti was awarded her MD from the University of Miami. She completed her Internal Medicine training at Massachusetts General Hospital and her GI training at Brigham and Women’s Hospital. She went on to receive an MPH degree from the Harvard School of Public Health in Clinical Effectiveness, with a focus on clinical trials.  

In 2020, Dr. Allegretti received the Sherman Emerging Leader Prize for Excellence in Crohn’s and Colitis and Healio Gastroenterology’s Clinical Innovation Award for her work on microbial therapeutics. 

Zain Kassam, MD, MPH is Co-Founder and Chief Medical Officer at Finch Therapeutics, a clinical-stage company focused on developing novel microbiome therapeutics. Previously, he was a founding team member and Chief Medical Officer at OpenBiome, the world’s first public stool bank for fecal microbiota transplantation, where he helped pioneer the universal donor model and expand safe access to patients suffering from Clostridioides difficile infection.

Dr. Kassam is a gastroenterologist, physician-scientist, and biotechnology entrepreneur dedicated to discovering and developing innovative microbiome therapeutics. He was named to the Top 40 Under 40 Healthcare Innovator List by MedTech and received the 2020 Public Health Innovator Award from the Harvard T.H. Chan School of Public Health. Dr. Kassam has served as a Scientific Advisory Board member for the American Gastroenterological Association Center for Gut Microbiome Research and Education, and as a Clinical Research Affiliate at the MIT Center for Microbiome Informatics and Therapeutics. He has authored more than 180 peer-reviewed publications, abstracts, and book chapters, including in leading journals such as the New England Journal of Medicine, Gastroenterology, and Gut. 

Dr. Kassam has been involved in more than 25 prospective microbiome therapeutic studies, including the first randomized trials in ulcerative colitis and hepatic encephalopathy. He has held funding from the Centers for Disease Control and Prevention, the Crohn’s and Colitis Foundation of America, and numerous private foundations. Dr. Kassam has been featured on PBS, CNN, BBC, The New Yorker, The Washington Post, and numerous other media outlets.

Dr. Kassam received his MPH degree from Harvard University in Quantitative Methods and completed his post-doctoral training in microbiome engineering at MIT. He was awarded his MD from Western University in London, Canada, where he received the Young Alumni Award for his contributions to the microbiome field. Dr. Kassam completed his Internal Medicine and Gastroenterology training at McMaster University, Hamilton, Ontario, Canada, where he was both the Chief Medical and Chief Gastroenterology Resident.