Moreover, the GPDA level has been shown to be elevated in the serum of patients with hepatocellular carcinoma and is proposed as a biomarker for diagnosing non-AFP–producing patients.35 Therefore, these alterations in serum indicators caused by PBC-FMT reflect the potential role of the gut microbiota in PBC, especially in bile duct injury. This evidence concerns the gene AFP and hepatocellular carcinoma.