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Even after successful Kasai portoenterostomy (KPE), progressive liver fibrosis ultimately dictates long\u2010term outcomes. The \u201cmicrobiome\u2010gut\u2010liver axis\u201d has fundamentally reshaped our understanding of liver disease pathogenesis, yet critical questions persist regarding how Kasai surgery reconfigures this axis and whether these changes actively contribute to fibrogenesis. This review traces a mechanistic cascade from anatomical remodeling through dysbiosis, metabolic disruption, immune dysregulation, and ultimately liver fibrosis. We examine how Kasai surgery physically reprograms the gut ecosystem through altered biliary\u2013enteric continuity and bile acid circulation; how microbial metabolites\u2014particularly secondary bile acids and short\u2010chain fatty acids\u2014orchestrate hepatic stellate cell behavior and shape the hepatic immune milieu; and how bacterial translocation sustains inflammation through Toll\u2010like receptor signaling. Recent evidence challenging the primacy of TLR4 in long\u2010term progression instead implicates TLR7 as a potential driver, while acknowledging its complex, context\u2010dependent role that may involve both pro\u2010fibrotic and counter\u2010regulatory functions. Building on this foundation, we critically assess emerging intervention strategies\u2014including probiotics, postbiotics, phage therapy, and personalized approaches\u2014weighing translational potential against current evidence gaps and safety considerations. We propose that post\u2010Kasai alterations in the bile acid pool may drive fibrogenesis through synergistic engagement of FXR and TLR pathways (including TLR4 and TLR7), and outline a stratified, dynamic intervention framework for precision microbiome management grounded in multi\u2010omics integration and longitudinal cohort studies. By synthesizing current knowledge while identifying key uncertainties, this review aims to inform both mechanistic investigation and the development of microbiome\u2010targeted adjunctive therapies for BA.<\/jats:p>","DOI":"10.1111\/hepr.70184","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T10:45:23Z","timestamp":1775817923000},"page":"648-661","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Microbiome\u2010Gut\u2010Liver Axis Drives Post\u2010Kasai Fibrosis in Biliary Atresia: From Mechanism to Precision Intervention"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5907-9436","authenticated-orcid":false,"given":"Jiwen","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Pediatrics First Affiliated Hospital of Xi'an Jiaotong University  Xi'an Shaanxi 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