Efficacy and safety of probiotics and prebiotics in liver transplantation: A systematic review and meta-analysis

A Systematic Review of the Effects of Probiotics and Synbiotics on Infection Incidence after Liver Transplant Surgery

Among organ transplant operations, liver transplantation (LTX) has one of the highest risks of postoperative infection. This study aimed to systematically review the current evidence on the use of probiotics and synbiotics in reducing the incidence of postoperative infections in liver transplant recipients. A systematic search was performed to identify studies that investigated the role of probiotics and synbiotics in reducing postoperative infection rates in liver transplant recipients. Eight studies that qualified were included in the review. The results showed that probiotics and synbiotics effectively reduced the overall infection rates in liver transplant patients compared with the placebo or control groups. This positive effect might be attributed to improved intestinal barrier function, gut microbiota restoration, and decreased inflammation. Furthermore, probiotic treatment was associated with shorter durations of antibiotic use and hospital stays. The use of probiotics and synbiotics after LTX holds promise in decreasing postoperative infections and providing substantial advantages for patients. Probiotics have been shown to boost the levels of beneficial bacterial, decrease inflammation, fortify the intestinal barrier, lessen oxidative stress, and improve the generation of anti-inflammatory short-chain fatty acids. However, more extensive research is needed to identify the most effective probiotic strains and evaluate their effectiveness in this specific patient demographic.

Probiotics as a possible novel therapeutic option to mitigate perioperative neurocognitive disorders: A review exploring the latest research findings

Perioperative neurocognitive disorders (PND) refer to a constellation of symptoms that primarily affect the elderly and typically manifest as common complications after exposure to surgery and anesthesia. PND is associated with high morbidity, mortality, and progression to neurodegenerative diseases, thus exerting significant financial strains on families as well as the healthcare system. Given that an ageing global population is an inevitable trend and, with the latest advances in the healthcare system, an ever-growing number of elderly people present for surgery and anesthesia, PND is of prominent concern. The two-way communication between the intestinal flora and the brain, also known as the microbiota-gut-brain axis, plays an important role in central nervous system development, and multiple studies have highlighted the influence exerted by gut microbiome in both health and disease. Pertinent studies have corroborated the fact that anesthesia and surgery disrupt the harmony of the gut ecology, which sets off a cascade of events that initiate neuroinflammation, eventually leading to PND. Probiotics, which are live microorganisms that promote the host's health, have been shown as a viable option to restore or minimise the disruption of gut flora. Evidence exists that probiotics exhibit immunomodulatory and anti-inflammatory benefits. Given the effectiveness of probiotics in reducing neuroinflammation, research has also focused on their impact on the development of PND. This review aims to compile the data from relevant clinical trials focusing on the influence of probiotics on PND to determine whether the derived findings might be applied for the prevention and treatment of PND.

The effect of perioperative probiotics and synbiotics on postoperative infections in patients undergoing major liver surgery: a meta-analysis of randomized controlled trials

Objective

To evaluate the effect of perioperative probiotics or synbiotics on the incidence of postoperative infections following major liver surgery.

Design

Meta-analysis.

Data sources

PubMed, Embase, Scopus, and the Cochrane Library for relevant English-language studies published up to February 21st, 2024.

Eligibility criteria

Randomized controlled trials evaluating perioperative probiotics or synbiotics for preventing postoperative infections in patients undergoing major liver surgery.

Data extraction and synthesis

Outcomes included postoperative infection incidence, antibiotic therapy duration, length of stay in intensive care unit (ICU) and hospital. A random-effect model was adopted for the meta-analysis. The quality of included studies was evaluated using the Cochrane risk of bias tool.

Results

Ten studies involving 588 patients were included. Pooled analyses revealed that perioperative probiotics or synbiotics significantly reduced postoperative infection incidence (RR 0.36, 95% CI [0.24-0.54], P < 0.0001, I2 = 6%) and antibiotic therapy duration (MD -2.82, 95% CI [-3.13 to -2.51], P < 0.001, I2 = 0%). No significant differences were observed in length of stay in ICU (MD -0.25, 95% CI [-0.84-0.34], P = 0.41, I2 = 64%) or length of stay in hospital (MD -1.25, 95% CI [-2.74-0.25], P = 0.10, I2 = 56%).

Conclusions

This meta-analysis suggests that perioperative administration of probiotics or synbiotics may reduce the incidence of postoperative infections and duration of antibiotic therapy. Their use as adjunctive therapy during the perioperative period could be considered for patients undergoing major liver surgery.

The role of gut barrier dysfunction in postoperative complications in liver transplantation: pathophysiological and therapeutic considerations

PURPOSE

Gut barrier dysfunction is a pivotal pathophysiological alteration in cirrhosis and end-stage liver disease, which is further aggravated during and after the operational procedures for liver transplantation (LT). In this review, we analyze the multifactorial disruption of all major levels of defense of the gut barrier (biological, mechanical, and immunological) and correlate with clinical implications.

METHODS

A narrative review of the literature was performed using PubMed, PubMed Central and Google from inception until November 29th, 2023.

RESULTS

Systemic translocation of indigenous bacteria through this dysfunctional barrier contributes to the early post-LT infectious complications, while endotoxin translocation, through activation of the systemic inflammatory response, is implicated in non-infectious complications including renal dysfunction and graft rejection. Bacterial infections are the main cause of early in-hospital mortality of LT patients and unraveling the pathophysiology of gut barrier failure is of outmost importance.

CONCLUSION

A pathophysiology-based approach to prophylactic or therapeutic interventions may lead to enhancement of gut barrier function eliminating its detrimental consequences and leading to better outcomes for LT patients.

A Pilot Study of Nephrogenic Probiotics to Further Improve an Already Stabilized Graft Function After Kidney Transplantation

BACKGROUND

The majority of kidney recipients are a subset of chronic kidney disease. Our previous study demonstrated that the combination of Lactobacillus plantarum and Lactobacillus paracasei (Lm) had the highest clearance ability of uremic toxins and improved kidney function in a mouse model. This study aimed to evaluate Lm in improving graft function, effects on immunosuppressants, and safety in transplant recipients.

METHODS

We retrospectively reviewed 24 patients. Twelve of them take Lm regularly; we compared the creatinine measurements and estimated glomerular filtration rate 3 months before and after Lm using a 2-tailed Wilcoxon matched-pairs signed-rank test while also evaluating the drug level of immunosuppressants and infection events. Other 12 patients who do not have Lm for evaluation of laboratory calibration and compared the proportion of improving creatinine using Fisher's exact test.

RESULTS

The creatinine decreased by 0.06 mg/dL (P = .02), and the estimated glomerular filtration rate increased by 3.1 mL/min/1.73 m2 (P = .03) after Lm supplementation. This pilot study revealed the association of higher incidence (odds ratio 13.3, 95% CI 1.64-77.2, P = .01) of decreasing creatinine in transplant recipients using Lm. Furthermore, results showed a trend of higher trough levels of tacrolimus and sirolimus, which might provide a potential strategy for reducing the dosages of immunosuppressants.

CONCLUSION

Our findings revealed an association between a higher incidence of decreasing creatinine in kidney transplant recipients using Lm, which may also provide a potential strategy for reducing the acquired dosages of immunosuppressants.

Why Give My Surgical Patients Probiotics

Although there are various hypotheses on the health-promoting roles probiotic supplementation play-via targeting the gut microbiota and/or regulating the systemic immune and metabolic responses-the precise nature of this benefit in restitution of health following surgery remains under discussion and in doubt [...].