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

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.

Influences of Oral Administration of Probiotics on Posthepatectomy Recovery in Patients in Child-Pugh Grade

“…It is well known that HCC is generally the last stage of the development of chronic liver disease, and liver resection is the preferred treatment for most patients [21]. But surgical stress induces dysbiosis, promotes the release of inflammatory cytokines, and increases the permeability of the intestinal barrier, leading to bacterial translocation [21,22].…”

“…It is well known that HCC is generally the last stage of the development of chronic liver disease, and liver resection is the preferred treatment for most patients [21]. But surgical stress induces dysbiosis, promotes the release of inflammatory cytokines, and increases the permeability of the intestinal barrier, leading to bacterial translocation [21,22]. The liver is exposed to microbiota and microbial metabolites through portal flow, which ultimately leads to increased infection and poor prognosis due to the limited detoxification function of the liver [21,23].…”

“…But surgical stress induces dysbiosis, promotes the release of inflammatory cytokines, and increases the permeability of the intestinal barrier, leading to bacterial translocation [21,22]. The liver is exposed to microbiota and microbial metabolites through portal flow, which ultimately leads to increased infection and poor prognosis due to the limited detoxification function of the liver [21,23]. The bidirectional relationship between the gut with its microbiota and the liver is known as the "gut-liver axis" [24].…”

Effects of Perioperative Probiotics and Synbiotics on Pancreaticoduodenectomy Patients: A Meta-Analysis of Randomized Controlled Trials

“…Second, probiotics can reduce intestinal flora translocation, subsequently reducing the incidence of infection (37). Further, probiotics and synbiotics protect the intestinal mucosal barrier, maintain normal intestinal mucosal permeability, and reduce toxin absorption (38)(39)(40). Finally, probiotics regulate innate and adaptive immune responses and enhance local immune function (27).…”

Why Give My Surgical Patients Probiotics

“…Incidents of pneumonia were also reduced in another similar meta-analysis of 13 RCTs [pooled OR = 0.56, 95% CI 0.32 to 0.98, p = 0.04] [ 17 ]. In 12 liver surgery studies, lower infection rates were presented [pooled RR = 0.46, 95%CI, 0.31 to 0.67] [ 18 ], while in 6 liver transplantation studies the overall infection rate [RR = 0.29, 95%CI, 0.14 to 0.60], urinary tract infections [OR = 0.14, 95%CI, 0.04 to 0.47] and the duration of antimicrobial therapy [WMD = −4.31, 95%CI, −5.41 to 0.47] were reduced, but there was no difference in pneumonia, peritonitis and cholangitis rates [ 19 ].…”