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

Probiotics were used for liver transplantation (LT) patients to reduce postoperative infection, but clinical trials examining the combined use of prebiotics and probiotics are limited. This meta-analysis aimed to compare the safety and efficacy of combined use of prebiotics and probiotics in patients undergoing LT. PubMed, Cochrane, and Embase databases were reviewed for the combined use of prebiotics and probiotics in patients undergoing LT. The weighted mean difference (WMD), risk ratio (RR), and 95% CI were calculated. A total of 6 related studies comprising 345 patients were included. Most prebiotics and probiotics were given for 7.14 days. The overall infection rate (RR = 0.29; 95% CI, 0.14.0.60; P value for heterogeneity [P-H] = .066; test for heterogeneity [I-2] = 51.7%) and the incidence of urinary tract infection (RR = 0.14; 95% CI, 0.04-0.47, P-H = .724; I-2 = 0%) were lower in the probiotics group when compared with those in the control group. Furthermore, probiotics significantly reduced the hospital length of stay (WMD = -1.37; 95% CI, -1.92 to 0.82; P-H = .506; I-2 = 0%) and the duration of antimicrobial therapy (WMD = -4.31; 95% CI, -5.41 to 3.22; P-H = .019; I-2 = 69.8%) in patients undergoing LT. These findings suggested that the combined use of prebiotics and probiotics (Lactobacillus and Bifidobacterium) was effective in lowering the incidence of bacterial infections and shortening the hospital length of stay and duration of antibiotic therapy in patients undergoing LT, when compared with conventional nutrition.