A review of engraftment assessments following fecal microbiota transplant Review


Authors: Herman, C.; Barker, B. M.; Bartelli, T. F.; Chandra, V.; Krajmalnik-Brown, R.; Jewell, M.; Li, L.; Liao, C.; McAllister, F.; Nirmalkar, K.; Xavier, J. B.; Caporaso, J. G.
Review Title: A review of engraftment assessments following fecal microbiota transplant
Abstract: Fecal Microbiota Transplant (FMT) is a treatment for recurrent Clostridium difficile infections and is being explored for other clinical applications, from alleviating digestive and neurological disorders, to restoring microbiomes impacted by cancer treatment. Quantifying the extent of engraftment following an FMT is important in understanding a recipient’s response to treatment. Engraftment and clinical response need to be investigated independently to evaluate an FMT’s role (or lack thereof) in achieving a clinical response. Standardized bioinformatics methodologies for quantifying engraftment extent would not only improve assessment and understanding of FMT outcomes, but also facilitate comparison of FMT results and protocols across studies. Here we review FMT studies, integrating three concepts from microbial ecology as framework to discuss how these studies approached assessing engraftment extent: 1) Community Coalescence investigates microbiome shifts following FMT engraftment, 2) Indicator Features tracks specific microbiome features as a signal of engraftment, and 3) Resilience examines how resistant post-FMT recipients’ microbiomes are to reverting back to baseline. These concepts explore subtly different questions about the microbiome following FMT. Taken together, they provide holistic insight into how an FMT alters a recipient’s microbiome composition and provide a clear framework for quantifying and communicating about microbiome engraftment. © 2025 The Author(s). Published with license by Taylor & Francis Group, LLC.
Keywords: genetics; review; nonhuman; animal; animals; classification; physiology; engraftment; pilot study; clostridium difficile infection; intestine flora; microbiology; bioinformatics; isolation and purification; neurologic disease; feces; therapy; bacterium; clostridium infection; protocol; clostridium infections; bacteria; drug concentration; microbiome; humans; human; fecal microbiota transplantation; bacteriotherapy; gastrointestinal microbiome; fecal microbiota transplant; clostridioides difficile; intestinal microbiota transplant; stool transplant
Journal Title: Gut Microbes
Volume: 17
Issue: 1
ISSN: 1949-0976
Publisher: Taylor & Francis Group  
Publication status: Published
Date Published: 2025-12-01
Online Publication Date: 2025-07-02
Start Page: 2525478
Language: English
DOI: 10.1080/19490976.2025.2525478
PUBMED: 40605266
PROVIDER: scopus
PMCID: PMC12233830
DOI/URL:
Notes: Review -- Source: Scopus
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  1. Joao Debivar Xavier
    99 Xavier
  2. Chen Liao
    20 Liao