BACKGROUND: Faecal microbiota transplantation (FMT) is an emerging treatment modality, but its current clinical use and organisation are unknown. We aimed to describe the clinical use, conduct, and potential for FMT in Europe. METHODS: We invited all hospital-based FMT centres within the European Council member states to answer a web-based questionnaire covering their clinical activities, organisation, and regulation of FMT in 2019. Responders were identified from trials registered at clinicaltrials.gov and from the United European Gastroenterology (UEG) working group for stool banking and FMT. FINDINGS: In 2019, 31 FMT centres from 17 countries reported a total of 1,874 (median 25, quartile 10-64) FMT procedures; 1,077 (57%) with Clostridioides difficile infection (CDI) as indication, 791 (42%) with experimental indications, and 6 (0•3%) unaccounted for. Adjusted to population size, 0•257 per 100,000 population received FMT for CDI and 0•189 per 100,000 population for experimental indications. With estimated 12,400 (6,100-28,500) annual cases of multiple, recurrent CDI and indication for FMT in Europe, the current European FMT activity covers approximately 10% of the patients with indication. The participating centres demonstrated high safety standards and adherence to international consensus guidelines. Formal or informal regulation from health authorities was present at 21 (68%) centres. INTERPRETATION: FMT is a widespread routine treatment for multiple, recurrent CDI and an experimental treatment. Embedded within hospital settings, FMT centres operate with high standards across Europe to provide safe FMT. A significant gap in FMT coverage suggests the need to raise clinical awareness and increase the FMT activity in Europe by at least 10-fold to meet the true, indicated need. FUNDING: NordForsk under the Nordic Council and Innovation Fund Denmark (j.no. 8056-00006B).

Centre for Clinical Infection and Diagnostics Research King's College London and Guy's and St Thomas' NHS Foundation Trust London United Kingdom

Centre for Microbiota Analysis and Therapeutics Leiden University Medical Centre Leiden the Netherlands

Clinic of Gastroenterology Tsaritsa Yoanna University Hospital Sofia Bulgaria

Department 1 of Internal Medicine University of Cologne Cologne Germany

Department Gastroenterology and Hepatology KU Leuven University Hospitals Leuven and KU Leuven Belgium

Department of Clinical Immunology Aarhus University Hospital Aarhus Denmark

Department of Clinical Research University of Southern Denmark Odense Denmark

Department of Gastroenterology and Hepatology Amsterdam University Medical Centers Amsterdam the Netherlands

Department of Gastroenterology and Hepatology Leiden University Medical Center Leiden the Netherlands

Department of Gastroenterology and Institute for Digestive Research Lithuanian University of Health Sciences Kaunas Lithuania

Department of Gastroenterology Ghent University Hospital Ghent Belgium

Department of Gastroenterology Haaglanden Medical Center The Hague the Netherlands

Department of Gastroenterology Helsinki University Hospital and Helsinki University Helsinki Finland

Department of Gastroenterology Hepatology and Infectious Diseases Otto von Guericke University Magdeburg Germany

Department of Gastroenterology Institute of Immunology and Immunotherapy University of Birmingham University Hospital Birmingham United Kingdom

Department of Gastrointestinal Surgery Aalborg University Hospital Aalborg Denmark

Department of Hepatology and Gastroenterology Aarhus University Hospital Palle Juul Jensens Boulevard 99 DK 8200 Aarhus Denmark

Department of Infectious Diseases Copenhagen University Hospital Hvidovre Denmark

Department of Internal Medicine 2 Infectious Diseases University Hospital Frankfurt Frankfurt am Main Germany

Department of Internal Medicine 4 Jena University Hospital Jena Germany

Department of Internal Medicine and Digestive Diseases IRD Toulouse 3 University Toulouse France

Department of Medical Gastroenterology Odense University Hospital Research Unit of Medical Gastroenterology Odense Denmark

Department of Medical Microbiology Leiden University Medical Center Leiden the Netherlands

Department of Medicine Zealand University Hospital Køge Denmark

Department of Metabolism Digestion and Reproduction Faculty of Medicine Imperial College London London United Kingdom

Department of Transplantation Medicine Oslo University Hospital Oslo Norway

Digestive Disease Center CEMAD Fondazione Policlinico Universitario Gemelli IRCCS Rome Italy

Division of Clinical Microbiology Linköping University Hospital Linköping Sweden

Division of Gastroenterology and Hepatology Medical University of Graz Graz Austria

ESCMID Study Group for Host and Microbiota Interaction Basel Switzerland

French Group of Faecal Microbiota Transplantation Paris France

Gastroenterology Department Centre Hospitalier de Thiers Thiers France

Gastroenterology Department Institut des maladies de l'Appareil Digestif Centre d'investigation Clinique IMAD University Hospital Hotel Dieu Nantes France

German Centre for Infection Research Partner site Bonn Cologne Germany

Hepatogastroenterology Department Institute for Clinical and Experimental Medicine 140 21 Prague Czech Republic

Human Microbiome Research Program Faculty of Medicine University of Helsinki Helsinki Finland

Infectious Diseases Service Centre Hospitalier Universitaire Vaudois University of Lausanne Lausanne Switzerland

INRA UMR1319 Micalis AgroParisTech Jouy en Josas France

Institute of Health and Society University of Oslo Oslo Norway

National Institute for Public Health and the Environment Bilthoven the Netherlands

National Reference Laboratory for Clostridium difficile Department of Medical Microbiology Leiden University Medical Center Leiden the Netherlands

Netherlands Donor Feces Bank Leiden University Medical Center Leiden the Netherlands

Nutrition Gut Brain Interactions Research Centre Faculty of Medicine and Health School of Medical Sciences Örebro University Örebro Sweden

Servicio de Gastroenterología y Hepatología Hospital Universitario Ramón y Cajal Madrid Spain

Sorbonne Université INSERM Centre de Recherche Saint Antoine CRSA AP HP Saint Antoine Hospital Gastroenterology Department Paris France

University Hospital of North Norway Harstad Harstad Norway

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