What is Fecal Transplantation?
Fecal Transplantation: This is a treatment method known as “Fecal Microbial Transplantation” in the world literature, but also known as “Stool Transplantation” among the public. The human feces are composed of 60 to 70% by volume of active and inactive flora waste.
What is Flora?
Certain parts of the human body are inhabited by microorganisms which peacefully live with us, do not harm us, contribute to the vital functions of the region in which they live, cause health problems when not present, whose functions cannot be compensated in any other way, which constantly renew themselves, whose diversity increases under favorable living conditions, and whose number and biodiversity decrease in some unfavorable conditions. Their general name is FLORA, and we can call them our BENEFICIAL MICROBES in the digestive system.
What is at stake is the flora of the digestive tract. The digestive system refers to the tract from the mouth to the anus. The digestive system is home to members of the flora throughout the mouth, throat, larynx, esophagus, stomach, small and large intestine, with unique functions at each site. Those are specific to the site they occupy and cannot inhabit or live in other sites.
The number of flora bacteria identified in the human digestive tract to date is 1054. Flora diversity is among the most important factors affecting quality of life.
HOW MANY TYPES OF FLORA BACTERIA DO HUMANS HARBOR IN THE ENTIRE DIGESTIVE SYSTEM?
The most important factor in this is the environmental conditions. Whereas the diversity of flora in those living in large metropolitan areas is as low as 50-60, this figure tends to increase in rural areas. In Turkey, people on average have a flora diversity of around 100 to 110 species throughout the entire digestive tract.
A high level of biodiversity of the digestive tract flora is directly proportional to a healthy, high quality and long life. Our flora members have diverse functions and are therefore indispensable for our health.
WHY IS FECAL TRANSPLANTATION PERFORMED?
What is aimed by fecal transplants to patients whose digestive tract flora has been damaged for whatever reason is to increase the biodiversity of the patient’s weakened flora.
HOW IS FECAL MICROBIAL TRANSPLANTATION PERFORMED?
Fecal transplantation is the process of collecting fecal material from at least one healthy fecal donor, subjecting the collected material to a number of procedures, and transplanting it into the patient’s digestive system through endoscopy and colonoscopy.
Fecal transplants by type are as follows:
- Fecal transplant from one donor to a single anatomical site
- Fecal transplant from multiple donors to a single anatomical site
- Fecal transplant from one donor to multiple anatomical sites
- Fecal transplant from multiple donors to multiple anatomical sites
HOW IS THE DONOR SELECTED IN FECAL TRANSPLANTATION?
Eligibility to be a donor for fecal transplantation is based on the conditions in Table 1.
Table 1: Exclusion Criteria for Donor Selection in Total Gastrointestinal Flora Transplantation
|
Criteria for the Last Three Months |
Criteria for the Last Six Months |
Time-Independent Criteria |
|
-Those hospitalized -Those receiving intravenous therapy -Those vaccinated with live vaccines -Those taking antibiotics -Those who use antifungals -Those treated for parasites -Those who use antivirals -Those undergoing dental treatment -Those who have had surgical interventions -Those with a history of animal bites -Those with open injuries -Those with diarrhea -Unprotected sexual intercourse -Those with active infection -Those who gave birth -Travel to risk areas
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-Chemotherapy -Radiotherapy -Hormonotherapy -Immunosuppressive therapy -Intensive care treatment -Oral STOP over 7 days -Major surgical intervention -Blood transfusion -Those with a history of HAV infection -Contact with pesticides |
-Being a carrier of HIV infection (AIDS) -Being a carrier of Hepatitis B infection -Being a carrier of Hepatitis C infection -Those with Chronic Infectious Diseases -Those with a BMI less than 20 kg/m2 -Those who are overweight with a BMI of more than 30 kg/m2 -Diabetic Patients on Insulin -Those with Autoimmune Diseases -Ulcerative Colitis Patients -Those with Crohn’s Disease -Those with Celiac Disease -Those with Lactose Intolerance -Those Diagnosed with Digestive System Cancer -Those who have had Digestive System Surgery (except Appendectomy) -Those breastfed less than 6 months -Those diagnosed with Leaky Gut Syndrome (LGS) -Drug addicts -Alcoholics -Healthcare workers -Prostitutes -Homosexuals -Those over 50 years of age -Schizophrenics -Autistics -Workers in toxic industries -Pregnant women -Those with oral stop for more than three weeks |
(*Source: Kanlioz M, Ekici U, Ferhatoğlu MF. Total Gastrointestinal Flora Transplantation in the Treatment of Leaky Gut Syndrome and Flora Loss. Cureus. 2022 Nov 3;14(11):e31071. doi: 10.7759/cureus.)
WHAT DETERMINES THE QUALITY OF A FECAL DONOR?
A person who meets the criteria in Table 1 above is designated as a “Fecal Donor Pre-Candidate”. The donor candidate then undergoes a series of biochemical and microbiological tests to determine whether the donor has an infectious disease. If the donor candidate also successfully passes these tests, then the donor quality is determined by scoring the donor candidate according to the criteria in Table 2 below.
Table 2: Donor Quality Scoring
| CRITERIA | SCORE | Donor Score | |||||||
| Age (years) | 0-20 years → 5 | 21-30 years→ 4 | 31-40 years→ 3 | 41-50 years→ 2 | 50+ years→ 1 | ||||
| Breast milk intake (months) | 1-6 months↓→ 6 | 6 months↑ → 9 | 9 months↑→ 12 | 12 months↑→15 | 24 months↑→18 | ||||
| Place of Residence | Rural → 10 | Urban→ 3 | Metropolis→ 0 | ||||||
| Chemotherapy | Not Received → 10 | Received → 0 | |||||||
| Radiotherapy | Not Received → 10 | Received → 0 | |||||||
|
Not Received → 10 | Received → 0 | |||||||
| 3Weeks↑Antibiotics | Not Received → 10 | Received → 0 | |||||||
| Immunosuppressive Therapy | Not Received → 10 | Received → 0 | |||||||
| Oral Stop | No oral stop→ 10 | 7 days ↓ → 5 | 7+ → 0 | ||||||
| Intensive care treatment | Not received→ 10 | 7 days ↓ → 5 | 7+ → 0 | ||||||
| History of DM | No → 10 | Prediabetes→ 3 | Diabetes → 0 | ||||||
| Allergic diseases | No → 5 | Yes → 0 | |||||||
| Autoimmune Disease | No → 5 | Yes → 0 | |||||||
| Autoimmune disease in family members | No → 2 | Yes → 0 | |||||||
| Industrial Food Consumption | No → 5 | Very little → 2 | Yes → 0 | ||||||
| History of Dysentery | No→ 5 | 3≤ → 2 | 4≥ → 0 | ||||||
| History of Gastroenteritis | No → 5 | 5≤ → 2 | 6≥ → 0 | ||||||
| GIS surgery | No → 10 | Yes → 0 | |||||||
| Chronic medication use | No → 5 | Yes → 0 | |||||||
| Nutritional disorder | No → 10 | Yes → 0 | |||||||
| Alcohol use | No → 10 | Rarely→ 2 | Very often → 0 | ||||||
| TOTAL SCORE: | |||||||||
| DONOR QUALITY BY SCORE*125 points and ↑: Ideal Donor
*100-124 points: Donor of Very Good Quality *90-99 points: Donor of Good Quality *80-89 points: Acceptable Donor *70-79 points: Donor of Poor Quality *69-↓ points: Donor of Very Poor Quality |
Total Donor Score:
|
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(*Source: Kanlioz M, Ekici U, Ferhatoğlu MF. Total Gastrointestinal Flora Transplantation in the Treatment of Leaky Gut Syndrome and Flora Loss. Cureus. 2022 Nov 3;14(11):e31071. doi: 10.7759/cureus.)
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