Abstract:
Introduction. The gut microbiota, as well as the gut-liver axis, play a significantly important role in the
fibrosis process. As fibrosis progresses to cirrhosis, it further worsens the microbiota, creating a vicious
cycle of dysbiosis. Recently, there has been a growing interest in potential treatments that modulate the
gut microbiota and the gut-liver axis in the treatment of cirrhosis. Antibiotic resistance in cirrhosis is a
major issue. In this context, fecal microbiota transplantation (FMT) has emerged as a potential strategy.
The aim of this study is to highlight the role of FMT in patients with chronic liver disease.
Materials and Methods. A critical analysis of the specialized literature from 2018 to 2025 was
conducted using databases such as PubMed, Elsevier, ScienceDirect, CGH Journal and MDPI.
Results. FMT has demonstrated significant promise in modulating the gut microbiota, reducing systemic
inflammation, and improving clinical outcomes in cirrhotic patients. Clinical studies suggest that FMT
restores beneficial microbial strains (Bifidobacterium, Lactobacillus) while reducing harmful pathogens
(Enterobacteriaceae, Clostridioides difficile), leading to improved gut barrier integrity and reduced
endotoxemia. FMT plays a crucial role in restoring microbial balance and improving liver function.
Studies suggest that FMT may prevent or delay complications, slow disease progression, and reduce
mortality in patients with decompensated cirrhosis. Patients receiving FMT exhibit decreased
inflammatory cytokines (IL-1, IL-6, TNF-α) and enhanced bile acid metabolism. It has shown potential
in reducing antibiotic-resistance gene (ARG) expression, particularly for beta-lactamases, lowering the
risk of multidrug-resistant bacterial infections. While preliminary findings are encouraging, further largescale,
randomized controlled trials are required to establish optimal treatment protocols, donor screening
methods, and long-term safety. Variability in donor microbiota composition, the lack of standardized
administration protocols and the need for repeated FMT treatments for sustained effects, present
obstacles to clinical implementation.
Conclusions. FMT presents a promising microbiome-based therapy for cirrhosis, with evidence
supporting its role in reducing complications and enhancing overall liver health. While preliminary
findings are encouraging, further large-scale, randomized controlled trials are required to establish
optimal treatment protocols, donor screening methods, and long-term safety. Future research should
explore synthetic microbiome therapies and personalized microbiota-based interventions.
