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European journal of gastroenterology & hepatology
Nov 01, 2025;37 (11): 1260-1268.

A systematic review and meta-analysis on the efficacy of fecal microbiome transplantation in patients with severe alcohol-associated hepatitis.

Evance Pakuwal, Jin Lin Tan, Richard J Woodman, Amanda J Page, Andrea M Stringer, Mohamed Asif Chinnaratha
Author Information
  1. Evance Pakuwal: Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
  2. Jin Lin Tan: Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
  3. Richard J Woodman: College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
  4. Amanda J Page: Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.
  5. Andrea M Stringer: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
  6. Mohamed Asif Chinnaratha: Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
PMID: 40359297 DOI: 10.1097/MEG.0000000000003003

Abstract

BACKGROUND: Severe alcohol-associated hepatitis (sAH) has a high short-term mortality, with limited treatment options. Fecal microbiota transplantation (FMT) has shown benefits in small, uncontrolled studies.
AIM: Perform a systematic review and meta-analysis to provide updated evidence on the efficacy and safety of FMT in sAH patients.
METHOD: Electronic databases were searched till 4 December 2023 for studies comparing FMT with standard of care (SOC) in sAH patients. Sensitivity analysis (leave-one-out method) and subgroup analyses were performed. Pooled risk ratio (RR) was used to compare the survival outcomes.
RESULTS: Eight studies with 444 patients (FMT: 218; SOC: 226) met the eligibility criteria and were included in this meta-analysis. The 28- and 90-day survival range was higher in the FMT group (75-100% and 53-87%) compared to the SOC group (48-80% and 25-56%). The random-effects model showed a statistically significant increase in survival in the FMT arm at 28 days [RR (95% confidence interval) 2.30 (1.24-4.28), P  = 0.01] and 90 days [2.53 (1.34-4.77), P  < 0.001]. However, there was no statistically significant change in survival at the 6-month [1.89 (0.89-4.05), P  = 0.10] and the 12-month time [1.86 (0.68-5.08), P  = 0.23]. Sensitivity analysis showed no major changes in the overall effect sizes, and subgroup analysis showed that the survival benefit was restricted only to the retrospective studies. No serious treatment-related adverse events were reported.
CONCLUSION: FMT is a safe and efficacious treatment option that improves short-term survival in sAH patients, without major adverse events. A multicentre randomized controlled trial with an adequate sample size is required to confirm these findings.

Keywords

fecal microbiome transplant microbiome therapy severe alcohol-associated hepatitis survival analysis

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MeSH Term

Humans
Fecal Microbiota Transplantation
Hepatitis, Alcoholic
Treatment Outcome
Severity of Illness Index
Journal Article Systematic Review Meta-Analysis

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