Background: Fecal microbiota transplantation (FMT) is validated for recurrent Clostridioides difficile infections but is increasingly considered for compassionate indications: steroid-refractory graft-versus-host disease (GVHD), multidrug-resistant organism (MDRO) eradication, severe inflammatory or infectious colitis. Evidence remains limited outside clinical trials.
Methods: Retrospective multicenter analysis of requests submitted to the French National Commission for compassionate FMT between 2019 and 2022. Approved cases were evaluated for feasibility, safety, and clinical outcomes.
Results: Among 67 requests, 54 were approved and 40 FMT procedures were performed. The main indications were severe steroid-resistant GVHD (35%), MDRO carriage (28%), and inflammatory/infectious colitis (12%). Overall success was 37.5%. The response rate for GVHD was 53% and 31% for MDRO eradication. Adverse events were mostly mild.
Conclusions: Compassionate FMT in France is feasible through a centralized process but shows variable efficacy depending on the indication. GVHD seems to be the most promising target, while MDRO eradication and colitis require further evaluation.
Keywords: BMR eradication; Digestive graft versus host disease; Fecal microbiota transplantation.
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