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Skinning the Cat Twice: Refractory CDI in a Solid Organ Transplant Patient Requiring 2 Fecal Microbiota Transplants Sarah Ordway, MD; Nieka Harris, MD; and Roy Wong, MD,MACG Presentation Recurrent Clostridium difficile infection (RCDI) remains a management challenge Fecal microbiota transplantation (FMT) is safe and efficacious for these patients There is a paucity of literature describing FMT efficacy and safety in solid organ transplant (SOT) patients Legend: = Occurrence of CDI = Hospital admission = FMT Cost Comparison A 64 year-old immunocompromised male with ESRD due to poorly controlled DMII and hypertension, 8 years status-post living donor kidney transplant, presented with abdominal pain, 48 hours of 10 loose stools and a positive C. difficile PCR following antibiotic exposure for healthcare-associated pneumonia Hospitalized with severe sepsis $200,000 $190,934 $180,000 $166,656 $160,000 $140,000 Healthcare Cost Introduction $120,000 $100,000 $80,000 CDI Severity $60,000 $40,000 Severe Pseudomembranous colitis Mild/Mod $23,437 $20,000 $13,103 $9,920 $231 $0 Total Cost Hospital Cost Baseline 11/12/13 11/26/13 12/9/13 1/6/14 3/21/14 3/30/14 4/10/14 Treatment before FMT Antibiotics $841 $2,952 Procedures FMT treatment Treatments required FMT was significantly more cost effective 12 November • 1 day oral metronidazole 500mg TID 13 November • 10 days Oral Vancomycin (OV) 125mg Q6H 9 December • 14 days OV 500mg Q6H No recurrences within 6 months of 2nd FMT 30 March • 1 day OV 250mg Q6H Discussion Solid organ transplant recipients suffer a higher frequency of CDI, tend to have more severe disease Our renal transplant patient achieved a lasting response following sequential FMT without infectious complications up to 6 months post FMT SOT recipients with RCDI who fail initial FMT may have more severe dysbiosis and may benefit from sequential FMT The views expressed are those of the authors, and do not reflect the opinion of the Walter Reed National Military Medical Center, the United States Army, or the United States Government.