# Advance Microbiota Transplantation: A Novel Addition–Subtraction Paradigm for Optimising Faecal Microbiota Transplantation

## TL;DR

The paper introduces a new framework for improving faecal microbiota transplantation by optimizing donor and recipient factors before, during, and after the procedure.

## Contribution

The novel 'addition–subtraction' paradigm in Advance Microbiota Transplantation aims to enhance FMT predictability and efficacy.

## Key findings

- AMT integrates donor and recipient optimization to address FMT limitations.
- The addition–subtraction strategy is proposed to shape AMT across transplant phases.
- Six under-reported items in FMT research were identified, affecting reproducibility.

## Abstract

Faecal microbiota transplantation (FMT) is highly effective for recurrent Clostridioides difficile infection but yields inconsistent benefits in chronic indications. As a crude whole‐microbiota transplant, FMT contains numerous undefined active components, complicating efforts to ensure treatment predictability and stability. Therefore, we propose Advance Microbiota Transplantation (AMT), a comprehensive, phase‐based hypothesis that employs an addition–subtraction strategy throughout the pre‐, peri‐ and post‐transplant stages. AMT comprises donor and recipient pre‐treatment, procedural optimisation and post‐transplant adjuvant interventions to mitigate donor variability, ecological resistance, procedural heterogeneity and unstable engraftment. Through a systematic synthesis of current evidence‐based FMT research, we explored how the addition–subtraction strategy can be operationalised to shape the AMT concept and define testable, phase‐specific levers, thereby providing a foundation for future clinical translation. In parallel, we appraised the reporting quality using the Preferred Reporting Items for Microbiotherapy (PRIM) and identified six persistently under‐reported items that limit the interpretability, comparability, and reproducibility of FMT research. This review aims to facilitate the integration of AMT into clinical practice.

This review proposes Advance Microbiota Transplantation (AMT), a pre‐peri‐post transplant ‘addition–subtraction’ framework that integrates donor–recipient optimisation, product engineering, and post‐transplant recipient adjuvant management to enhance conventional FMT efficacy and mitigate its limitations.