Effects of continuous use of probiotics before liver transplantation: A randomized, double-blind, placebo-controlled trial

Clin Nutr. 2017 Dec;36(6):1530-1539. doi: 10.1016/j.clnu.2017.04.021. Epub 2017 May 4.


Background & aims: Although there is increasing evidence for the benefits of probiotics in patients with liver diseases, data on the benefits of pre-LT administration of probiotics are lacking. The aim of this study was to evaluate the effects of continuous administration of probiotics before liver transplantation (LT) on pre- and post-transplant patient outcomes.

Methods: In this randomized, double-blind, and placebo-controlled trial adult cirrhotic patients listed for LT received a 4-strain probiotic preparation or placebo daily from enrollment until LT. The primary outcome measures were postoperative mortality and infection rates. The secondary outcome measures were 5-day post-transplant aspartate and alanine aminotransferase activities, bilirubin concentration, and international normalized ratio; waiting-list mortality; pre-transplant Model for End-stage Liver Disease score and Child-Turcotte-Pugh class changes; and pre-transplant infections.

Results: A total of 55 patients were randomized. The 90-day postoperative mortality rates were 0% and 4.3% in the probiotic and placebo groups, respectively (p > 0.99). Patients receiving probiotics had significantly reduced 30-day (4.8% versus 34.8%, p = 0.02) and 90-day (4.8% versus 47.8%, p = 0.002) infection rates, lower post-LT bilirubin concentration (p = 0.02), and more rapid decrease of aspartate (p = 0.03) and alanine (p = 0.03) aminotransferase activities. Probiotics did not have significant effects on other secondary outcome measures.

Conclusions: Although continuous administration of probiotics before LT does not appear to affect postoperative mortality, it effectively prevents postoperative infections and improves early biochemical parameters of allograft function. CLINICALTRIALS.

Gov identifier: NCT01735591.

Keywords: Allograft function; Liver transplantation; Nutrition; Postoperative infections; Probiotics.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Alanine Transaminase / blood
  • Aspartate Aminotransferases / blood
  • Colony Count, Microbial
  • Double-Blind Method
  • Feces / microbiology
  • Female
  • Gastrointestinal Microbiome
  • Humans
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Postoperative Complications / prevention & control
  • Preoperative Care*
  • Probiotics / administration & dosage*
  • Prospective Studies
  • Treatment Outcome


  • Aspartate Aminotransferases
  • Alanine Transaminase

Associated data

  • ClinicalTrials.gov/NCT01735591