title: Supply of pre- and probiotics reduces bacterial infection rates after liver transplantation--a randomized, double-blind trial.
abstract: Bacterial infections frequently occur early after liver transplantation. We recently reported significant progress with a synbiotic composition, consisting of one lactic acid bacteria (LAB) and one fiber, which reduced the infection rate from 48% (with selective bowel decontamination) to 13%. Now, our aim is to study if a combination of different LAB and fibers would further improve outcome. A prospective randomized double-blind trial was undertaken in 66 liver transplant recipients. All patients received enteral nutrition immediately post-operatively. Comparison was made between one group (A) receiving a composition of four LAB and four fibers and another group (B) receiving the fibers only. The treatment started the day before surgery and continued for 14 days. Thirty-day infection rate, length of hospital stay, duration of antibiotic therapy, non-infectious complications and side effects of enteral nutrition were recorded. The incidence of post-operative bacterial infections was significantly reduced; being 48% with only fibers and 3% with LAB and fibers. In addition, the duration of antibiotic therapy was significantly shorter in the latter group. In both groups, mainly mild or moderate infections occurred. Fibers and LAB were well tolerated. Early enteral nutrition supplemented with a mixture of LAB and fibers reduces bacterial infection rates following liver transplantation. Treatment with only fibers led to a low incidence of severe infections.
authors.affiliation: Department of General, Visceral and Transplant Surgery, Charite Campus Virchow, Humboldt University, Berlin, Germany. nada.rayes@charite.de
authors.forename: Nada
authors.initials: N
authors.lastname: Rayes
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.forename: Tom
authors.initials: T
authors.lastname: Theruvath
authors.forename: Reinhold A
authors.initials: RA
authors.lastname: Schiller
authors.forename: Jan M
authors.initials: JM
authors.lastname: Langrehr
authors.forename: Sven
authors.initials: S
authors.lastname: Jonas
authors.forename: Stig
authors.initials: S
authors.lastname: Bengmark
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000517:prevention & control*; D004311:Double-Blind Method; D004750:Enteral Nutrition; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006760:Hospitalization; D006801:Humans; D016867:Immunocompromised Host; D019344:Lactic Acid / Q000378:metabolism; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011228:Prealbumin / Q000096:biosynthesis; D019936:Probiotics / Q000627:therapeutic use*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011228:Prealbumin; D019344:Lactic Acid