Gut Microbiome in Liver Transplantation: From Preoperative Status to Posttransplant Outcomes

Liver transplantation remains the gold standard treatment for patients with end-stage liver disease. Despite significant improvement in surgical care and postoperative medical care, complications in the posttransplant period remain a concern. Graft rejection due to immunological factors is associated with increased morbidity and mortality. Infectious complications also have a major impact on patient outcomes. There is growing evidence about the role of the gut microbiome in the perioperative liver transplant course and the impact on patient outcomes in liver transplantation. These patients often already have gut dysbiosis at the time of liver transplantation due to their severe underlying disease and the use of repeated antibiotic courses. In this comprehensive review, we compile the current evidence for the role of the gut microbiome during the liver transplantation period.