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International consensus conference on stool banking for faecal microbiota transplantation in clinical practice
Open accessAbstract
infection (CDI), its widespread dissemination is limited by several obstacles, including lack of dedicated centres, difficulties with donor recruitment and complexities related to regulation and safety monitoring. Given the considerable burden of CDI on global healthcare systems, FMT should be widely available to most centres.Stool banks may guarantee reliable, timely and equitable access to FMT for patients and a traceable workflow that ensures safety and quality of procedures. In this consensus project, FMT experts from Europe, North America and Australia gathered and released statements on the following issues related to the stool banking: general principles, objectives and organisation of the stool bank; selection and screening of donors; collection, preparation and storage of faeces; services and clients; registries, monitoring of outcomes and ethical issues; and the evolving role of FMT in clinical practice,Consensus on each statement was achieved through a Delphi process and then in a plenary face-to-face meeting. For each key issue, the best available evidence was assessed, with the aim of providing guidance for the development of stool banks in order to promote accessibility to FMT in clinical practice.
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“Both the increase in clinical requests for FMT to prevent rCDI and the high level of required quality controls have led to the development of stool banks that provide widespread and equitable access to FMT together with high safety, quality, and traceable workflows. 22”
From Key determinants of success in fecal microbiota transplantation: From microbiome to clinic (2023) · cites this paper as [22]
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Self-citationApplications of human organoids in the personalized treatment for digestive diseases
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Ianiro, G., Bibbò, S., Porcari, S., Settanni, C. R., Giambò, F., Curta, A. R., Quaranta, G., Scaldaferri, F., Masucci, L., Sanguinetti, M., et al. (2021) · Gut Microbes · doi:10.1080/19490976.2021.1994834 · Cited by 64
“Fecal microbiota transplantation (FMT) is an established therapy for recurrent CDI (rCDI),(9,10) as recommended by international guidelines.(11,12) Increasing evidence suggests that FMT is safe and effective in patients with IBD and rCDI, improves disease activity and reduces the need for escalation of IBD therapy.”
MethodSelf-citationRelationship between Gut Microbiota and Allergies in Children: A Literature Review
Pantazi, A. C., Mihai, C. M., Bălașa, A. L., Chisnoiu, T., Lupu, A., Frecuș, C. E., Mihai, L., Ungureanu, A., Kassim, M. A. K., Andrusca, A., et al. (2023) · Nutrients · doi:10.3390/nu15112529 · Cited by 80
“Fecal microbiota transplantation is a method which can normalize the gut microbiota of the affected individuals through replacement of that microbiota with another microecosystem from a healthy individual [80], and it has been proving effective in treating many conditions such as recurrent Clostridium difficile infect…”
MethodFecal microbiota transplantation: Uses, questions, and ethics
Grigoryan, Z., Shen, M. J., Twardus, S. W., Beuttler, M. M., Chen, L. A., & Bateman-House, A. (2020) · Medicine in Microecology · doi:10.1016/j.medmic.2020.100027 · Cited by 63
“difficile, among other pathogenic organisms [62,63].”
Lu, G., Wang, W., Li, P., Wen, Q., Cui, B., & Zhang, F. (2022) · Microbial Biotechnology · doi:10.1111/1751-7915.14074 · Cited by 59
“So far, water, sterile saline, phosphate-buffered saline have been used as a vector solvent of faecal material (Liao and Shollenberger, 2003; Mattila et al., 2012; Cammarota et al., 2017, 2019).”
MethodFuture Modulation of Gut Microbiota: From Eubiotics to FMT, Engineered Bacteria, and Phage Therapy
Airola, C., Severino, A., Porcari, S., Fusco, W. G., Mullish, B. H., Gasbarrini, A., Cammarota, G., Ponziani, F. R., & Ianiro, G. (2023) · Antibiotics · doi:10.3390/antibiotics12050868 · Cited by 68
Self-citationAllogeneic hematopoietic cell transplantation, the microbiome, and graft-versus-host disease
van Lier, Y. F., Vos, J., Blom, B., & Hazenberg, M. D. (2023) · Gut Microbes · doi:10.1080/19490976.2023.2178805 · Cited by 66
“Importantly, transfer of pathogens, including multidrug-resistant bacterial strains(105) and infectious viruses,(106) has been described, emphasizing the importance of careful selection and screening of FMT donors.(107) Finally, not the microbial populations themselves but the metabolites they produce could be repleni…”
BackgroundChallenges and costs of donor screening for fecal microbiota transplantations
Bénard, M. V., de Bruijn, C. M. A., Fenneman, A. C., Wortelboer, K., Zeevenhooven, J., Rethans, B., Herrema, H., van Gool, T., Nieuwdorp, M., Benninga, M. A., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0276323 · Cited by 58
“Nevertheless, the most relevant in- and exclusion criteria were similar and our approach is in line with current available screenings protocols [14, 23].”
BackgroundResultSelf-citationFecal microbiota transplantation as a promising treatment option for osteoporosis
Zhang, Y., Cao, M., Li, Y., Zhang, R., Wu, M., Yu, Q., & Rui, Y. (2022) · Journal of Bone and Mineral Metabolism · doi:10.1007/s00774-022-01375-x · Cited by 60
Du, C., Luo, Y., Walsh, S., & Grinspan, A. M. (2021) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001495 · Cited by 57
Fecal microbiota transplantation in clinical practice: Present controversies and future prospects
Tian, H., Wang, X., Fang, Z., Li, L., Wu, C., Bi, D., Li, N., Chen, Q., & Qin, H. (2024) · hLife · doi:10.1016/j.hlife.2024.01.006 · Cited by 56
“The second stage builds upon this by incorporating life history screening [12].”
Porcari, S., CICCARESE, C., Heidrich, V., Rondinella, D., Quaranta, G., Severino, A., Arduini, D., Buti, S., Fornarini, G., Primi, F., et al. (2026) · Nature Medicine · doi:10.1038/s41591-025-04189-2 · Cited by 62
“Immediately after this step, they were manufactured as fecal aliquots for colono-scopic FMT and/or as FMT capsules, based on specific needs related to planned treatments, following recommendations by international guidelines 32,40,41 .”
InfluentialSelf-citationFecal microbiota transplantation in non-communicable diseases: Recent advances and protocols
Hamamah, S., Gheorghita, R. E., Lobiuc, A., Sîrbu, I. O., & Covașă, M. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.1060581 · Cited by 57
“for the provision of safe and correct treatment (148).”
BackgroundRode, A. A., Chehri, M., Krogsgaard, L. R., Heno, K. K., Svendsen, A. T., Ribberholt, I., Helms, M., Engberg, J., Schønning, K., Tvede, M., et al. (2021) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.16309 · Cited by 51
“Any corticosteroid use since last CDI 5 (15) 6 (18) 8 (26)”
BackgroundKarjalainen, E. K., Renkonen‐Sinisalo, L., Satokari, R. M., Mustonen, H. K., Ristimaki, A. P., Arkkila, P. E. T., & Lepistö, A. (2021) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izab001 · Cited by 51
“14,15 Research has also investigated FMT in other disorders with increasing intensity.”
BackgroundSelf-citationTegegne, H. A., & Savidge, T. (2025) · Gut Microbes · doi:10.1080/19490976.2025.2569739 · Cited by 59
“103,104 Although the U.S. Food and Drug Administration (FDA) has begun to issue guidance, achieving global regulatory coherence will require coordinated efforts through international bodies such as the World Health Organization (WHO) and the Organisation for Economic Co-operation and Development…”
Reygner, J., Charrueau, C., Delannoy, J., Mayeur, C., Robert, V., Cuinat, C., Meylheuc, T., Mauras, A., Augustin, J., Nicolis, I., et al. (2020) · Gut Microbes · doi:10.1080/19490976.2020.1759489 · Cited by 51
“Here, we assessed the performance of a new freeze-drying process using non-penetrating cryoprotectants, and compared over time results with those obtained with the corresponding samples stored frozen at −80°C after dilution in glycerol, a penetrating cryoprotective agent at both concentrations (G10 and G80) currently…”
ResultInfluentialVendrik, K. E. W., Terveer, E. M., Kuijper, E. J., Nooij, S., Boeije-Koppenol, E., Sanders, I. M. J. G., van Lingen, E., Verspaget, H. W., Berssenbrugge, E. K. L., Keller, J. J., et al. (2021) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30473-4 · Cited by 49
Self-citationPorcari, S., Ng, S. C., Zitvogel, L., Sokol, H., Weersma, R. K., Elinav, E., Gasbarrini, A., Cammarota, G., Tilg, H., & Ianiro, G. (2025) · Cell · doi:10.1016/j.cell.2025.04.016 · Cited by 56
Self-citationThe gut microbiota promotes pain in fibromyalgia
Cai, W., Haddad, M., Haddad, R., Kesten, I., Hoffman, T., Laan, R., Westfall, S., Defaye, M., Abdullah, N. S., Wong, C., et al. (2025) · Neuron · doi:10.1016/j.neuron.2025.03.032 · Cited by 59
Mari, A., Baker, F. A., Mahamid, M., Sbeit, W., & Khoury, T. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9030685 · Cited by 57
“Recent international consensus of stool banking f r FMT hav involved experts from Europe, North America, and Australia wh roposed consensus guideline statements regarding several issues in stool banking, including the selection of donors and screening objectives, collection and processing of stool samples, monitoring…”
BackgroundScaldaferri, F., Ianiro, G., Privitera, G., Lopetuso, L. R., Vetrone, L. M., Petito, V., Pugliese, D., Neri, M., Cammarota, G., Ringel, Y., et al. (2020) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izaa181 · Cited by 47
Self-citationExperimental human hookworm infection: a narrative historical review
Chapman, P. R., Giacomin, P., Loukas, A. C., & McCarthy, J. S. (2021) · PLoS neglected tropical diseases · doi:10.1371/journal.pntd.0009908 · Cited by 48
“These standardised criteria would also be relevant for hookworm faeces donation [77].”
BackgroundHalkjær, S. I., Lo, B. Z. S., Cold, F., Christensen, A. H., Holster, S., König, J., Brummer, R. J., Aroniadis, O. C., Lahtinen, P., Holvoet, T., et al. (2023) · World Journal of Gastroenterology · doi:10.3748/wjg.v29.i20.3185 · Cited by 48
Gossip in the gut: Quorum sensing, a new player in the host-microbiota interactions
Coquant, G., Aguanno, D., Pham, S., Grellier, N., Thenet, S., Carrière, V., Grill, J.-P., & Seksik, P. (2021) · World Journal of Gastroenterology · doi:10.3748/wjg.v27.i42.7247 · Cited by 47
Laube, R., Selinger, C. P., Seow, C. H., Christensen, B., Flanagan, E. K., Kennedy, D. S., Mountifield, R. E., Seeho, S. K. M., Shand, A., Williams, A., et al. (2023) · Gut · doi:10.1136/gutjnl-2022-329304 · Cited by 45
Clostridioides difficile and Gut Microbiota: From Colonization to Infection and Treatment
Spigaglia, P. (2024) · Pathogens · doi:10.3390/pathogens13080646 · Cited by 53
“Internationally, panels of experts are involved in its methodological implementation, the standardization of stool banks, and quality assurance to guarantee accessibility to FMT worldwide [184,185].”
BackgroundPérez-Matute, P., Íñiguez, M., de Toro, M., Recio-Fernández, E., & Oteo, J. A. (2020) · Scientific Reports · doi:10.1038/s41598-020-64961-x · Cited by 42
Innes, A. J., Mullish, B. H., Ghani, R., Szydlo, R., Apperley, J. F., Olavarría, E., Palanicawandar, R., Kanfer, E., Milojković, D., McDonald, J. A. K., et al. (2021) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2021.684659 · Cited by 42
“The FMT used in all procedures had been previously prepared in house anaerobically and stored at -80°C for less than six months, using 10% w/v glycerol as cryopreservative (Mullish et al., 2015; Cammarota et al., 2019).”
MethodSelf-citationDissecting mechanisms of fecal microbiota transplantation efficacy in disease
Andary, C. M., Al, K. F., Chmiel, J. A., Gibbons, S., Daisley, B. A., Parvathy, S. N., Vareki, S. M., Bowdish, D. M. E., Silverman, M., & Burton, J. P. (2024) · Trends in Molecular Medicine · doi:10.1016/j.molmed.2023.12.005 · Cited by 46
Fecal Microbiota Transplantation during and Post-COVID-19 Pandemic
Kazemian, N., Kao, D. H., & Pakpour, S. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22063004 · Cited by 41
“The logistics of selecting and screening donors as well as optimizing the efficacy of this treatment are the main constraints of the therapeutic uses of FMT [6].”
BackgroundMethodSelf-citationHow to Apply FMT More Effectively, Conveniently and Flexible – A Comparison of FMT Methods
Varga, A., Kocsis, B., Sipos, D., Kása, P., Vigvári, S., Pál, S., Dembrovszky, F., Farkas, N., & Péterfi, Z. (2021) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2021.657320 · Cited by 42
The emerging potential ofmicrobiome transplantation on human health interventions
Junca, H., Pieper, D. H., & Medina, E. (2022) · Computational and Structural Biotechnology Journal · doi:10.1016/j.csbj.2022.01.009 · Cited by 41
“Blastocystis hominis and Dientamoeba fragilis [88].”
The Evolving Landscape of Fecal Microbial Transplantation
Shao, T., Hsu, R., Hacein-Bey, C., Zhang, W., Gao, L., Kurth, M. J., Zhao, H., Shuai, Z., & Leung, P. S. C. (2023) · Clinical Reviews in Allergy & Immunology · doi:10.1007/s12016-023-08958-0 · Cited by 43
From hype to hope: Considerations in conducting robust microbiome science
McGuinness, A. J., Stinson, L. F., Snelson, M., Loughman, A., Stringer, A. M., Hannan, A. J., Cowan, C. S. M., Jama, H. A., Caparros-Martin, J. A., West, M. L., et al. (2023) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2023.09.022 · Cited by 44
“However, the ongoing development of “ stool banks ” and standardised synthetic microbiomes, alongside regulatory frameworks and guidelines for FMT globally, is promising (Cammarota et al., 2019), and hints towards a future where FMT will be more accessible.”
Garavaglia, B., Vallino, L., Amoruso, A., Pane, M., Ferraresi, A., & Isidoro, C. (2024) · Aspects of Molecular Medicine · doi:10.1016/j.amolm.2024.100056 · Cited by 48
Baunwall, S. M. D., Dahlerup, J. F., Engberg, J., Erikstrup, C., Helms, M., Juel, M. A., Kjeldsen, J., Nielsen, H. L., Nilsson, A. C., Rode, A. A., et al. (2021) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2021.1922749 · Cited by 45
“For one treatment, 50 grams of donor stool is recommended [138].”
BackgroundKenneth, M. J., Tsai, H., Fang, C., Hussain, B., Chiu, Y., & Hsu, B. (2022) · Journal of Advanced Research · doi:10.1016/j.jare.2022.12.015 · Cited by 44
“In FMT, faecal material, including bacteria and natural antibacterial agents, is transferred from a healthy individual to a patient’s intestine as treatment [135], which is possibly to be the most direct means manipulating the gut microbiota [136].”
BackgroundNagakubo, D., & Kaibori, Y. (2023) · Microorganisms · doi:10.3390/microorganisms11092307 · Cited by 70
Nooij, S., Ducarmon, Q. R., Laros, J. F. J., Zwittink, R. D., Norman, J. M., Smits, W. K., Verspaget, H. W., Keller, J. J., Terveer, E. M., & Kuijper, E. J. (2021) · Gastroenterology · doi:10.1053/j.gastro.2021.06.009 · Cited by 38
Self-citation
Metadata
- Authors
- Cammarota, G., Ianiro, G., Kelly, C. R., Mullish, B. H., Allegretti, J. R., Kassam, Z., Putignani, L., Fischer, M., Keller, J. J., Costello, S. P., Sokol, H., Kump, P., Satokari, R., Kahn, S. A., Kao, D., Arkkila, P., Kuijper, E. J., Vehreschild, M. J. G., Pintus, C., Lopetuso, L., Masucci, L., Scaldaferri, F., Terveer, E. M., Nieuwdorp, M., López-Sanromán, A., Kupcinskas, J., Hart, A., Tilg, H., & Gasbarrini, A.
- Affiliations
- Agostino Gemelli University Polyclinic (IT)
- Brown University (US)
- Philipps University of Marburg (DE)
- Brigham and Women's Hospital (US)
- OpenBiome (US)
- Bambino Gesù Children's Hospital (IT)
- Indiana University Indianapolis (US)
- Leiden University Medical Center (NL)
- Queen Elizabeth Hospital (AU)
- Inserm (FR)
- Medical University of Graz (AT)
- University of Helsinki (FI)
- Boston Children's Hospital (US)
- University of Alberta (CA)
- University Hospital Cologne (DE)
- Tissues and Cells Area, Italian National Transplant Center, Rome, Italy
- Amsterdam UMC Location University of Amsterdam (NL)
- Gastroenterology and Hepatology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Department of Gastroenterology, Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- St Mark's Hospital (GB)
- Innsbruck Medical University (AT)
- Corresponding author
- Cammarota, Giovanni
- ORCID
- Cammarota, Giovanni
- Ianiro, Gianluca
- Kelly, Colleen R
- Mullish, Benjamin H
- Allegretti, Jessica R
- Kassam, Zain
- Putignani, Lorenza
- Fischer, Monika
- Keller, Josbert J
- Costello, Samuel Paul
- Sokol, Harry
- Satokari, Reetta
- Kahn, Stacy A
- Kao, Dina
- Arkkila, Perttu
- Kuijper, Ed J
- Vehreschild, Maria J GT
- Lopetuso, Loris
- Masucci, Luca
- Scaldaferri, Franco
- Terveer, E M
- Nieuwdorp, Max
- Hart, Ailsa
- Tilg, Herbert
- Gasbarrini, Antonio
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2019-09-28
- Volume
- 68
- Issue
- 12
- Pages
- 2111-2121
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC6872442
- OpenAlex
- W2976599382
- Cited by
- 506
- References
- 109
- Citations by year
- 2026: 74 · 2025: 63 · 2024: 87 · 2023: 61 · 2022: 57 · 2021: 73 · 2020: 86 · 2019: 5
- FWCI
- 42.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Gut (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- HAL (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Työväentutkimus Vuosikirja (submittedVersion)
- Lithuanian University of Health Sciences (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, other-oa)
- Spiral (Imperial College London) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- fecal microbiota transplantation, Clostridium difficile infection, donor screening, donor recruitment, safety monitoring
- MeSH terms
- Gastrointestinal Microbiome, Fecal Microbiota Transplantation, Clostridium Infections, Humans, Specimen Handling, Clostridioides difficile, Consensus, Donor Selection
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