Impact of two-session fecal microbiota transplantation on minimal hepatic encephalopathy in cirrhosis

Figure 1 Consort chart. HCC: Hepatocellular carcinoma; HE: Hepatic encephalopathy; MELD: Model for end stage liver disease; FMT: Fecal microbiota transplantation; MI: Myocardial infarction; AKI: Acute kidney injury.

Figure 2 Changes in psychometric hepatic encephalopathy score and components of psychometric hepatic encephalopathy score over 3 months. A-F: Components of psychometric hepatic encephalopathy score. DST: Digit symbol test; FCT: Figure connection test; SDT: Serial-dotting test; PHES: Psychometric hepatic encephalopathy score; NCT-A: Number connection test-A; LTT: Line-tracing test; FMT: Fecal microbiota transplantation.

Figure 3 Alpha diversity and taxonomic abundance comparisons in donors, fecal microbiota transplantation, and lactulose groups. A-D: Alpha diversity metrics (Observed, Chao1, Shannon, and Simpson indices) comparing microbiota diversity across different groups: Donor, fecal microbiota transplantation (FMT) baseline, after 3 months (n = 37), lactulose baseline, and after 3 months (n = 46). The Boxplots show the median, interquartile range, and individual data points (differences among groups, P > 0.05, Tukey-HSD test, non-parametric test); E: A heat map illustrating taxonomic abundance and comparisons among donors, minimal hepatic encephalopathy responders, and non-responders in the FMT and Lactulose groups after 3 months; F-H: Box plots showing the mean relative abundance of (%) of Bifidobacterium (P = 0.02, t-test), Escherichia (P = 0.20, t-test), and Enterococcus (P = 0.37, t-test) between responders and non-responders after 3 months in FMT group. FMT_0: Fecal microbiota transplantation baseline; FMT_3M: Fecal microbiota transplantation after 3 months; Lactulose_0: Lactulose baseline; Lactulose_3M: Lactulose after 3 months; R: Responders; NR: Non-responders.

Figure 4 Functional analysis of minimal hepatic encephalopathy responders and non-responders in the fecal microbiota transplantation group. A and B: Differential abundance analysis using edgeR (P-adjusted < 0.05). Principal component analysis plot comparing minimal hepatic encephalopathy responders (R) and non-responders (NR) (A). Heatmap displaying the 36 differentially enriched metabolic pathways between R and NR, represented by Z scores (B); C: Heatmap showing the proportion of individuals testing positive for antimicrobial resistance genes among donors, baseline (fecal microbiota transplantation and lactulose), after 3 months (R and NR) for both fecal microbiota transplantation and lactulose. The Y-axis represents the different antimicrobial resistance genes, and the X-axis represents the various groups. R: Responders; NR: Non-responders; PC: Principal component; FMT: Fecal microbiota transplantation; NDM: New Delhi metallo-β-lactamase; CTX.M: Cefotaxime-Munich; KPC: Klebsiella pneumoniae carbapenemase; TEM: Temoniera; Cat:; AAC: Aminoglycoside acetyltransferase; Sul2: Sulfonamide-resistant dihydropteroate synthase 2; oqxa: Olaquindox resistance efflux pump subunit A; OXA: Oxacillinase; Tet: Tetracycline resistance gene/protei; aadA: Aminoglycoside adenylyltransferase A; sul1: Sulfonamide-resistant dihydropteroate synthase 1; ermB: Erythromycin ribosome methylase B; dfrA: Dihydrofolate reductase A; qnrS: Quinolone resistance gene S; mphA: Macrolide phosphotransferase A.