title: Patients Receiving Prebiotics and Probiotics Before Liver Transplantation Develop Fewer Infections Than Controls: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  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 the 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.
  
  
  METHODS
  We searched PubMed and EMBASE for controlled trials that evaluated the effects of prebiotics and probiotics on infections in patients who underwent liver transplantation. Heterogeneity was analyzed by the Cochran 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. The 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 with 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, 1.41 d; P < .001), as well as in the intensive care unit (mean difference, 1.41 d; P < .001), and duration of antibiotic use (mean difference, 3.89 d; 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.
  
  
  CONCLUSIONS
  Based on the meta-analysis, giving patients a combination of probiotics and prebiotics before, 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 the duration of antibiotic use.
authors.affiliation: Department of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: tareksawas@yahoo.com.
authors.forename: Tarek
authors.initials: T
authors.lastname: Sawas
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Shadi
authors.initials: S
authors.lastname: Al Halabi
authors.affiliation: Department of Gastroenterology and Hepatology, John Hopkins, Baltimore, Maryland.
authors.forename: Ruben
authors.initials: R
authors.lastname: Hernaez
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: William D
authors.initials: WD
authors.lastname: Carey
authors.affiliation: Department of Gastroenterology and Hepatology, Georgetown University Medstar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Won Kyoo
authors.initials: WK
authors.lastname: Cho
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology* / Q000517:prevention & control*; D018988:Bacterial Translocation; D018849:Controlled Clinical Trials as Topic; D006801:Humans; D059413:Intraabdominal Infections / Q000453:epidemiology / Q000517:prevention & control; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects*; D056692:Prebiotics / Q000008:administration & dosage*; D011300:Preoperative Care / Q000379:methods*; D019936:Probiotics / Q000008:administration & dosage*; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D056692:Prebiotics
keywords: Drug; ICU; NNT; Treatment