Cirrhosis is the final common pathway of many chronic liver diseases and is associated with significant morbidity and mortality. Recent advances have revealed that the gut microbiota and the phenomenon of bacterial translocation play a fundamental role in the progression and complications of cirrhosis. This includes the development of hepatic encephalopathy, systemic inflammation, renal dysfunction, and sarcopenia. This comprehensive review explains the gut-liver axis in cirrhosis, the mechanisms and clinical consequences of bacterial translocation, the features of dysbiosis across different aetiologies such as metabolic dysfunction-associated fatty liver disease, and the immune dysregulation characteristic of cirrhotic patients. We also highlight how these processes contribute to major complications such as hepatic encephalopathy and sarcopenia, and we discuss emerging therapeutic opportunities.