Profile of Gut Microbiota Associated With the Presence of Hepatocellular Cancer in Patients With Liver Cirrhosis M. Grąt a, *, K.M. Wronka a , M. Krasnodębski a , L. Masior a , Z. Lewandowski b , I. Kosi  nska c , K. Grąt d , J. Stypulkowski a , S. Rejowski a , M. Wasilewicz a , M. Galęcka e , P. Szachta e , and M. Krawczyk a a Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland; b Department of Epidemiology, Medical University of Warsaw, Warsaw, Poland; c Department of Preventive Medicine and Hygiene, Medical University of Warsaw, Warsaw, Poland; d Second Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland; and e Institute of Microecology, Pozna n, Poland ABSTRACT Background. Changes within the gut microbiota contribute to the progression of chronic liver diseases. According to the results of several studies performed in animal models, gut dysbiosis plays an important role in hepatocarcinogenesis. The aim of this study was to explore the characteristics of gut microbiota associated with the presence of hepatocellular cancer (HCC) in patients with cirrhosis of the liver undergoing liver transplantation. Methods. A total of 15 patients with HCC and 15 non-HCC patients matched according to etiology of cirrhosis and Model for End-Stage Liver Disease (MELD) scores who underwent liver transplantations between 2012 and 2014 were included. Analysis of their gut microbial profile was based on prospectively collected stool samples from the pretransplant period. Results. Patients with and without HCC were similar with respect to age (P ¼ .506), sex (P ¼ .700), hepatitis C virus (P > .999) and hepatitis B virus (P ¼ .715) infection status, alcoholic liver disease (P > .999), and MELD score (P ¼ .337). Notably, the presence of HCC was associated with significantly increased fecal counts of Escherichia coli (P ¼ .025). Pre- diction of HCC presence based on E coli counts was associated with the area under the receiver-operating curve of 0.742 (95% confidence interval, 0.564e0.920), with the optimal cutoff on the level of 17.728 (natural logarithm of colony-forming units per 1 g of feces). Sensitivity and specificity rates for the established cutoff were 66.7% and 73.3%, respectively. Conclusions. The profile of gut microbiota associated with the presence of HCC in cirrhotic patients is characterized by increased fecal counts of E coli. Therefore, intestinal overgrowth of E coli may contribute to the process of hepatocarcinogenesis. T HE ROLE of gut microbiota in the development and progression of liver diseases seems substantial [1,2]. Through a system of complex interactions within the gute liver or microbiotaeliver axis, alterations in gut homeostasis may specifically lead to an inflammatory response within the liver and subsequent fibrogenesis [3,4]. Increased produc- tion of pro-inflammatory cytokines largely depends on the response of the innate immune system to the presence of microbial products, such as lipopolysaccharides (LPS) or other pathogen-associated molecular patterns recognized by pattern recognition receptors, in the portal circulation [3]. The profile of gut microbiota in patients with liver cirrhosis differs considerably from that observed in patients without liver disease [5e7]. Moreover, the degree of liver insuffi- ciency is closely related to the severity of gut dysbiosis [8]. This research was funded with budgetary resources for sci- ence for the years 2012 to 2015 as a scientific project of the program entitled “Diamond Grant” of the Ministry of Science and Higher Education of the Republic of Poland (DI2011025641). *Address correspondence to Michal Grąt, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, 1A Banacha St, 02-097 Warsaw, Poland. E-mail: michal.grat@gmail.com ª 2016 Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 0041-1345/16 http://dx.doi.org/10.1016/j.transproceed.2016.01.077 Transplantation Proceedings, 48, 1687e1691 (2016) 1687