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Meta-Analysis
. 2020 Aug 15;12(8):2461.
doi: 10.3390/nu12082461.

Effects of both Pro- and Synbiotics in Liver Surgery and Transplantation with Special Focus on the Gut-Liver Axis-A Systematic Review and Meta-Analysis

Judith Kahn  1 , Gudrun Pregartner  2 , Peter Schemmer  1
Affiliations
Meta-Analysis

Effects of both Pro- and Synbiotics in Liver Surgery and Transplantation with Special Focus on the Gut-Liver Axis-A Systematic Review and Meta-Analysis

Judith Kahn et al. Nutrients. .

Abstract

The gut-liver axis is of upmost importance for the development of infections after surgery. Further bacterial translocation due to surgery-related dysbiosis is associated with limited detoxification function of the liver compromising outcome of surgical therapy. After liver surgery, about 30% of patients develop a bacterial infection, with the risk of bacteremia or even sepsis-associated liver failure and mortality in >40%. The potential benefit of pro-/synbiotics given before surgery is still under debate. Thus, a systematic literature search on trials comparing patients with or without supplementation and outcome after liver resection or transplantation was performed. Our search strategy revealed 12 relevant studies on perioperative administration of pro-/synbiotics in liver surgery. The pro-/synbiotic combinations and concentrations as well as administration timeframes differed between studies. Five studies were performed in liver transplantation and 7 in liver resection. All studies but one reported lower infection rates (pooled RR: 0.46, 95% CI: 0.31-0.67) with pro-/synbiotics. Liver function was assessed after LT/LR in 3 and 5 studies, respectively. Pro-/synbiotics improved function in 1/3 and 2/5 studies, respectively. Concluding, perioperative pro-/synbiotics clearly reduce infection after liver surgery. However, standard protocols with both well-defined probiotic strain preparations and administration timeframes are pending.

Keywords: gut–liver axis; liver surgery; liver transplantation; pro-/synbiotic.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart depicting the screening and selection process for the systematic review of pro-/synbiotics on the prevention of infections and perioperative liver function.
Figure 2
Figure 2
Risk of bias summary: review of authors’ judgement on the risk of bias for the analyzed randomized controlled trials. Red circle symbolizes high risk of bias, green circle symbolizes low risk of bias, yellow circle symbolizes unclear risk of bias.
Figure 3
Figure 3
Forest plot of trials on perioperative pro-/synbiotics and their effect on infection stratified by type of surgery: liver resection (LR), liver transplantation (LT).
Figure 4
Figure 4
Forest plot of randomized controlled trials on perioperative pro-/synbiotics and their effect on infection stratified by type of surgery: liver resection (LR), liver transplantation (LT).
See this image and copyright information in PMC

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