Alterations in the Gut Microbiota of Cirrhotic Patients With Sarcopenia and PH After TIPS

Transjugular intrahepatic portosystemic shunt (TIPS) can effectively reduce portal hypertension (PH) and may be associated with improvement in muscle status; however, its impact on the gut microbiota and muscle condition remains unclear. Therefore, this prospective study aimed to evaluate gut microbiota alterations in patients with sarcopenia and PH after TIPS treatment.

Gut microbiota analysis was prospectively conducted in 20 cirrhotic patients with sarcopenia and PH receiving TIPS and their first-degree healthy family between December 2019 and July 2021 in our center. Fecal samples were collected before and 3 months after TIPS and analyzed by 16S rRNA sequencing. Microbial diversity and composition were assessed using standard bioinformatic pipelines. Sarcopenia was defined by L3 skeletal muscle index according to European Association for the Study of the Liver criteria.

Compared with healthy controls, cirrhotic patients with sarcopenia and PH exhibited significantly reduced α-diversity (Chao1, Shannon, Simpson; all P < 0.001) and distinct β-diversity clustering, confirming gut dysbiosis. Although TIPS did not significantly alter overall α-diversity, a significant increase in the order Burkholderiales and a reduction in Pseudomonadales and Staphylococcales were detected after TIPS. Analysis of the family taxonomic rank revealed that TIPS was followed by an increase in a greater abundance of Ruminococcaceae and Sutterellaceae and decreased levels of Tannerellaceae, Marinifilaceae, and Pseudomonadaceae. At the genus level, after TIPS placement, increased levels of Lachnospiraceae _ND3007_group, Intestinibacter , Fusicatenibacter , and Faecalibacterium and lower abundances of Pseudomonas , Prevotella , Peptostreptococcus , Parabacteroides , Muribaculaceae , and Butyricimonas were detected. Sarcopenia reversal was observed in 25% of patients, characterized by enrichment of short-chain fatty acid-producing genera such as Faecalibacterium and Streptococcus , whereas patients without improvement showed high abundance of Fusicatenibacter and low levels of beneficial taxa.

TIPS induces significant taxonomic shifts without changing overall diversity in cirrhotic patients with sarcopenia and PH, suggesting partial microbial restoration. Enrichment of short-chain fatty acid-producing bacteria may correlates with improved sarcopenia, whereas proinflammatory taxa may indicate poor recovery and higher risk of complications. These findings highlight the gut-muscle-liver axis and support microbiome-based biomarkers and interventions to optimize outcomes after TIPS.