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Eguchi et al (2010) Perioperative synbiotic treatment to prevent infectious complications in patients after elective living donor liver transplantation. A prospective randomised study

Eguchi et al (2010) Perioperative synbiotic treatment to prevent infectious complications in patients after elective living donor liver transplantation. A prospective randomised study

Citation

Eguchi S, Tatatsuki M, Hidaka M, Soyama A, Ichikawa T, Kanematsu T (2010) Perioperative synbiotic treatment to prevent infectious complications in patients after elective living donor liver transplantation. A prospective randomized study. The American Journal of Surgery 201(4):498-502.

Objective

To determine if a synbiotic intervention can reduce infectious complications in patients undergoing living donor liver transplantation (LDLT).

Methods

Adult patients (n=50) who had elected to undergo LDLT were randomised to the following two groups: (i) given a synbiotic preparation for two days before the operation and two weeks after the operation, (ii) not given synbiotic. The synbiotic consisted of two probiotic strains (15mg live Bifidobacterium breve strain Yakult and 20mg live Lactobacillus casei Shirota, equivalent to approx. 1.5 x 108 CFU bifidobacteria and 8 x 107 CFU lactobacilli) and prebiotic galacto-oligosacharides (a daily dose of 15g Oligomate 55; Yakult Honsha). Administration of the synbiotic was done three times daily, either orally or via a jejunostomy.

As part of the standard procedure for this type of operation, all patients received intravenous prophylaxis for four days (amoxicillin and cefotiam). Immunosuppressive treatments were also given, either dual or triple, including tacrolimus or cyclosporine A, prednisolone, and/or mycophenolate mofetil. Twenty-four hours after the operation, all patients received enteral nutrition through a jejunostomy.

Records were kept of any postoperative infectious complications and the faecal microbiota of the patients was analysed before and after their surgery.

[Explanatory note: LDLT is always partial transplantation; postoperative portal hypertension is higher with this surgery compared with whole-live transplantation].

Results

A significant reduction in infectious complications was observed in the synbiotic group (1/25, 4%) compared to the control (6/25, 24%) (P

One systemic infection occurred after surgery in the synbiotic group (Enterobacter asburiae), compared to six infectious complications in the control group (three cases of sepsis and three urinary tract infections with Enterococcus spp). Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from the blood of three of the control group who developed sepsis. It was noted that urinary infections was particularly higher in the control group compared to the synbiotic group.

One intra-abdominal infection occurred in the synbiotic group (Klebsiella oxytoca; Enterococcus faecium) compared to two in the control group (Enterobacter asburiae; Enterococcus faecium).

Post-operative dates of infection varied; some episodes occurred after the synbiotic intervention period finished.

There was no significant difference in the faecal microbiota between the two groups, but after the liver transplant together with immunosuppressive treatment, Enterococcus spp. was found in 25% of the patients, regardless of synbiotic intervention.

Conclusions

The authors concluded that there was a significant decrease in infectious complications after elective living donor liver transplantation, which was associated with perioperative administration of the synbiotic product.

 
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