Fecal Microbial Transplantation Shows Promise for Treating Gastrointestinal Acute Graft-Versus-Host Disease in Patients

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Frontiers in Medicine Published May 22, 2026 Medically reviewed May 22, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

FMT significantly improves response rates for GI-aGVHD without increasing infection risk compared to standard immunosuppressive therapy.

This meta-analysis evaluated the efficacy and safety of fecal microbial transplantation (FMT) versus conventional regimens involving corticosteroids and immunosuppressants for patients with acute graft-versus-host disease. The study included a total of 262 patients across various settings to assess clinical outcomes and microbial changes.

results indicated that FMT was associated with significantly higher rates of complete response at both 14 and 30 days for those with gastrointestinal involvement. Specifically, the odds ratio for complete response was 8.54, suggesting a substantial benefit over standard therapies for this specific condition.

Safety analysis revealed no significant differences in the incidence of bacteremia or sepsis between the two groups. Additionally, FMT treatment led to increased abundances of beneficial bacteria such as Bacteroides and Bifidobacterium compared to conventional management.

The findings suggest that FMT can serve as an effective adjunctive or salvage treatment for patients with established gastrointestinal acute graft-versus-host disease who may respond poorly to conventional regimens.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

ObjectiveIn recent years, fecal microbiota transplantation (FMT) has been increasingly investigated for the prevention and treatment of acute graft-versus-host disease (aGVHD). Nevertheless, its clinical efficacy remains uncertain. Therefore, this study aims to systematically evaluate the clinical efficacy of FMT in preventing and treating aGVHD.MethodsWe systematically searched Cochrane Library, PubMed, Embase, and Web of Science from inception to October 2025 for studies comparing FMT with conventional regimens (corticosteroids and/or immunosuppressants) for aGVHD prevention and treatment. All statistical analyses were performed using RevMan 5.4.1 and Stata 16.ResultsSix studies involving 262 patients were included. Among them, 85 patients received FMT for aGVHD prevention, 65 received conventional prophylaxis, 68 received FMT for Gastrointestinal aGVHD (GI-aGVHD) treatment, and 44 received conventional treatment for GI-aGVHD. Meta-analysis showed no significant difference in the incidence of aGVHD between the FMT and conventional groups [odds ratio (OR) = 1.30, 95% confidence interval (CI) = 0.10-16.72, p = 0.84]. However, the FMT group demonstrated significantly higher 14-day and 30-day complete response (CR) rates, as well as 14-day clinical response rates, in patients with GI-aGVHD compared to the conventional group (OR = 8.54, 95% CI = 2.49–29.29, p = 0.0007; OR = 8.44, 95% CI = 2.98–23.96, p < 0.0001; OR = 4.66, 95% CI = 1.73–12.55, p = 0.002). No significant differences were observed in the incidence of bacteremia or sepsis between the two groups (OR = 0.37, 95% CI = 0.13–1.01, p = 0.05; OR = 0.38, 95% CI = 0.11–1.33, p = 0.13). Additionally, the abundances of Bacteroides and Bifidobacterium were significantly higher in the FMT group than in the conventional group [standardized mean difference (SMD) = 1.59, 95% CI = 0.15–3.03, p = 0.03; SMD = 1.01, 95% CI = 0.41–1.60, p = 0.0009].ConclusionFMT showed favorable effects in improving clinical symptoms of GI-aGVHD and increasing the abundance of beneficial gut bacteria, and no increased risk of bloodstream infection was observed. These findings suggest that, for patients with established GI-aGVHD who may respond poorly to conventional regimens, FMT can serve as an effective adjunctive or salvage treatment. However, no significant advantage was observed for FMT in preventing aGVHD.