Cardiac allograft vasculopathy following fecal microbiota transplantation for recurrent C. difficile infection

Transpl Infect Dis. 2018 Dec;20(6):e12983. doi: 10.1111/tid.12983. Epub 2018 Sep 19.


We report the case of a 3-year-old male who developed recurrent Clostridium difficile infection after receiving an orthotopic heart transplant. Despite multiple courses of antibiotics, C. difficile infection was persistent and he underwent a fecal microbiota transplant. The patient responded with resolution of his diarrhea. However, within 2 months he developed severe mixed rejection with high circulating donor-specific antibodies and significant coronary vasculopathy. Organ dysfunction led to the need for re-transplantation. The patient's postoperative course has since been complicated by pneumatosis intestinalis and recurrent C. difficile infection.

Keywords: CAV; FMT; cardiac allograft vasculopathy; clostridum difficile; fecal microbiota transplant; heart transplant.

Publication types

  • Case Reports

MeSH terms

  • Allografts / blood supply*
  • Allografts / immunology
  • Anti-Bacterial Agents / therapeutic use
  • Child, Preschool
  • Clostridioides difficile / isolation & purification
  • Clostridium Infections / microbiology
  • Clostridium Infections / therapy*
  • Coronary Vessels / immunology
  • Fecal Microbiota Transplantation / adverse effects*
  • Graft Rejection / immunology*
  • Graft Rejection / surgery
  • Heart Transplantation / adverse effects*
  • Humans
  • Male
  • Myocardium / immunology
  • Recurrence
  • Reoperation
  • Vascular Diseases / immunology*
  • Vascular Diseases / surgery


  • Anti-Bacterial Agents