Giving patients a combination of probiotics and prebiotics prior to, or on the day of, liver transplantation significantly reduces the rate of infection after surgery. - GreenMedInfo Summary

BACKGROUND & AIMS: Among patients who have received liver transplants, infections increase morbidity and mortality and prolong hospital stays. Administration of antibiotics and surgical trauma create intestinal barrier dysfunction and microbial imbalances that allow enteric bacteria to translocate to the blood. Probiotics are believed to prevent bacterial translocation by stabilizing intestinal barrier and stimulating proliferation of the intestinal epithelium, mucus secretion, and motility. We performed a meta-analysis to determine the effects of probiotics on infections in patients receiving liver transplants.

METHOD: We searched PubMed and EMBASE for randomized controlled trials that evaluated the effects of prebiotics and probiotics on infections in patients that underwent liver transplantation. Heterogeneity was analyzed by Cochran's Q statistic. Pooled Mantel-Haenszel relative risks were calculated with a fixed effects model.

RESULTS: We identified 4 controlled studies, comprising 246 participants (123 received probiotics, 123 served as controls), for inclusion in the meta-analysis. In these studies, the intervention groups received enteric nutrition and fiber (prebiotics) with probiotics and the control groups received only enteric nutrition and fiber without probiotics. Infection rate was 7% in groups that received probiotics vs 35% in control groups (relative risk [RR], 0.21; 95% confidence interval [CI], 0.11-0.41; P=.001). The number needed to treat to prevent 1 infection was 3.6. In subgroup analyses, only 2% of subjects in the probiotic groups developed urinary tract infections, compared with 16 % of controls (RR, 0.14; 95% CI, 0.04-0.47; P<.001); only 2% of subjects in the probiotic groups developed intra-abdominal infections, compared to 11% of controls (RR, 0.27; 95% CI, 0.09-0.78; P=.02). Subjects receiving probiotics also had shorter stays in the hospital than controls (mean difference of 1.41 day; P<.001), as well as in the intensive care unit (mean difference of 1.41 day; P<.001) and duration of antibiotic use (mean difference of 3.89 days; P<.001). There was no difference in mortality between groups (RR, 0.97; 95% CI, 0.21-4.47). There was no significant heterogeneity among studies.

CONCLUSION: Based on a meta-analysis, giving patients a combination of probiotics and prebiotics prior to, or on the day of, liver transplantation reduces the rate of infection after surgery. These agents also reduced the amount of time spent in the hospital or intensive care unit and duration of antibiotic use.