Efficacy of Probiotics Supplementation on the Prognosis of Patients After Liver Transplantation: a Systematic Review and Meta-analysis

Preclinical evidence suggests that gut microbiome regulation may prove to be a new therapeutic target for treating postoperative infection in liver transplant recipients. This review aims to evaluate the most current evidence for the efficacy of probiotics supplementation on postoperative prognosis. The registered through the International prospective register of systematic reviews as CRD42020170379. We searched PubMed, Embase, and Cochrane Library databases for studies published from 1 Jan 1963 to 31 May 2021. The quality of included studies was assessed using the Cochrane risk of bias tool. Study heterogeneity was assessed with the Cochrane Q test and I² statistic. We applied leave-one-out sensitivity analysis to assess the effect of every single study on the heterogeneity and pooled effect size. Egger’s test and observation of funnel plots were used to detecting small-study effects and publication bias. A total of five studies, including 290 patients, were enrolled in the final analysis. Probiotics supplementation resulted in a beneficial outcome both in postoperative infection (RR = 0.199, 95%CI: 0.105 ~ 0.377, p = 0.000), the duration of antibiotic therapy (WMD = 3.031, 95%CI: − 5.905 ~  − 0.157, p = 0.039), and the length of hospital stay (SMD =  − 0.274, 95%CI: − 0.530 ~  − 0.018, p = 0.036). The main effective infection types were urinary tract infection (RR = 0.176, 95%CI: 0.063 ~ 0.496, p = 0.001) and intraabdominal infection (RR = 0.225, 95%CI: 0.084 ~ 0.607, p = 0.003), but not pneumonia infection (RR = 0.301, 95%CI: 0.076 ~ 1.203, p = 0.089). There were no statistically significant differences for the intensive care unit stay (WMD =  − 0.752, 95%CI: − 1.819 ~  − 0.315, p = 0.167) and postoperative mortality (RR = 0.794, 95%CI: 0.210 ~ 3.008, p = 0.734) in the two groups. Probiotics supplementation as an effective assistant treatment for reducing postoperative infection rates, the duration of antibiotic therapy, and the length of hospital stay after liver transplantation has application prospects.