Postoperative gut dysbiosis in biliary atresia patients treated by portoenterostomy or liver transplantation.

PURPOSE: To assess how surgery and management protocols affect gut microbiota in postoperative biliary atresia (BA) patients by comparing survivors with native livers (NL) or transplanted livers (TL) with healthy non-surgical controls (CL).

METHODS

Subjects were 62 post-portoenterostomy BA patients divided into 2 groups (NL and TL) and CL. All subjects were clinically stable with no dietary restrictions throughout the study period. Stool samples were compared for gut microbiota, organic acids, and fecal bile acids, while blood samples were compared for serum biochemistry and serum bile acids.

RESULTS

Stool samples from CL (n = 30) were normal while NL (n = 31) and TL (n = 31) showed gut dysbiosis with significantly decreased total bacteria and reduced predominance of obligate anaerobes, and an abundance of Clostridioides difficile, Enterobacteriaceae, and Enterococcus. The latter two were more abundant in TL than NL. Biochemistry was normal in TL. In NL, elevated AST/ALT correlated with increased Clostridioides difficile, decreased Bacteroides fragilis group, and decreased Lactobacilli. Fecal secondary bile acids were lower and serum primary and secondary bile acids were higher in NL and TL compared with CL.

CONCLUSION

Gut dysbiosis was present in both NL and TL. Pathogenic florae were more abundant in TL despite TL biochemistry being normal.