Fecal microbiota transplantation in cirrhosis: a microbiome-based therapeutic revolution

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.