{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T21:35:16Z","timestamp":1779312916388,"version":"3.51.4"},"reference-count":25,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T00:00:00Z","timestamp":1774742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background and Aims: Severe alcohol-associated hepatitis (SAH) can trigger unstable decompensations in cirrhosis patients. They experience high rates of emergency department visits and hospitalization. We evaluated real-world clinical outcomes following palliative-faecal microbiota transplantation (pFMT) compared to best supportive care (BSC) in this critically ill population. Patients and Methods: From July 2021 to April 2024, 28 patients on pFMT were compared with 37 on BSC. Patients on pFMT received nasoduodenal healthy donor stool infusion daily for 5-days. Patients were followed up for portal hypertension-related events, infections, hospitalizations, extrahepatic organ failure and 6- and 12-months survival. 16S rRNA sequencing on stool samples collected at baseline and on follow up were analysed for changes in relative abundance (RA) of bacterial communities. Results: Patients were matched for age, type of decompensation and liver disease severity at enrolment. Twelve-month survival was 64.3% in pFMT versus 51.4% in BSC groups. pFMT dramatically reduced hospital readmissions (mean 0.76 \u00b1 0.76 vs. 2.29 \u00b1 1.27, p &lt; 0.001). Unstable decompensations beyond 3 months occurred in 14.3% of pFMT versus 64.9% of BSC (p &lt; 0.001). Organ failures were lesser with pFMT: acute kidney injury 7.7% versus 93.8% (p &lt; 0.001), hepatic encephalopathy 7.1% versus 68.2% (p &lt; 0.001). Infection burden was significantly lower (53.6% vs. 83.8%, p = 0.008), particularly infections requiring admission (17.4% vs. 66.7%, p &lt; 0.001) with pFMT. Microbiome analysis revealed progressive expansion of Gram-negative genera in BSC, and beneficial Actinobacteria in pFMT-treated patients at 3, 6, and 12 months. Conclusions: Palliative FMT represents a unique disease-modifying intervention in end-stage alcohol-related cirrhosis, preventing organ failure progression, reducing healthcare utilization, and improving survival trajectories.<\/jats:p>","DOI":"10.3390\/jcm15072607","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T08:22:36Z","timestamp":1774858956000},"page":"2607","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Palliative Healthy Donor Stool Transplantation (pFMT) in Patients with End-Stage Alcohol-Related Cirrhosis and Severe Unstable Decompensations\u2014A Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0511-5002","authenticated-orcid":false,"given":"Tharun Tom","family":"Oommen","sequence":"first","affiliation":[{"name":"Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva 683112, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cyriac Abby","family":"Philips","sequence":"additional","affiliation":[{"name":"Clinical and Translational Hepatology, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva 683112, Kerala, India"},{"name":"Department of Clinical Research, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva 683112, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rizwan","family":"Ahamed","sequence":"additional","affiliation":[{"name":"Gastroenterology and Advanced GI Endoscopy, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva 683112, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3570-3465","authenticated-orcid":false,"given":"Arif Hussain","family":"Theruvath","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, The Liver Institute, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva 683112, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajit","family":"Tharakan","sequence":"additional","affiliation":[{"name":"Gastroenterology and Advanced GI Endoscopy, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva 683112, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3293-1817","authenticated-orcid":false,"given":"Sasidharan","family":"Rajesh","sequence":"additional","affiliation":[{"name":"Division of Interventional Radiology, Gastroenterology and Hepatology, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva 683112, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Augustine","sequence":"additional","affiliation":[{"name":"Gastroenterology and Advanced GI Endoscopy, Center of Excellence in Gastrointestinal Sciences, Rajagiri Hospital, Aluva 683112, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"20503121241297000","DOI":"10.1177\/20503121241297000","article-title":"A comprehensive review of diagnosis and management of alcohol-associated hepatitis","volume":"12","author":"Philips","year":"2024","journal-title":"SAGE Open Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.cld.2021.01.009","article-title":"Acute decompensation and acute-on-chronic liver failure","volume":"25","author":"Ferstl","year":"2021","journal-title":"Clin. 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