Introduction: Bacterial infections remain a major cause of morbidity after liver transplantation despite advances in perioperative care. Synbiotics, combining probiotics and prebiotics, have been proposed to reduce postoperative infections by restoring gut microbiota and strengthening intestinal barrier function.
Introduction:
Bacterial infections remain a major cause of morbidity after liver transplantation despite advances in perioperative care. Synbiotics, combining probiotics and prebiotics, have been proposed to reduce postoperative infections by restoring gut microbiota and strengthening intestinal barrier function. Earlier studies suggested potential benefits, but their findings have not been consistently replicated in clinical practice.
Why was this study needed?:
. Previous studies suggested synbiotics may reduce post-transplant bacterial infections, but the evidence was inconsistent.
. Synbiotic therapy has not been widely adopted in liver transplant programs.
. High-quality randomized controlled data were needed to validate their effectiveness.
. It remained uncertain whether postoperative synbiotics improve clinically meaningful outcomes after liver transplantation.
Results:
In this randomized, double-blind, placebo-controlled trial, postoperative synbiotic supplementation for 14 days did not reduce bacterial infections compared with placebo. There were no significant differences between the groups in antibiotic use, acute rejection, hospital length of stay, or short-term survival. Per-protocol analyses yielded similar findings, confirming the absence of a meaningful clinical benefit. Synbiotic therapy was well tolerated but failed to improve postoperative outcomes.
Clinical Impact:
This study challenges earlier reports supporting routine synbiotic supplementation after liver transplantation. The findings indicate that postoperative synbiotics should not be recommended as standard care solely to prevent bacterial infections. Future research should focus on identifying specific patient populations, alternative microbiome-based interventions, or different treatment strategies that may offer greater clinical benefit.
Bottom Line:
Routine postoperative synbiotic supplementation does not reduce bacterial infections or improve short-term clinical outcomes after liver transplantation and should not be incorporated into standard postoperative management based on current evidence.
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