Jorgenson Margaret R, Descourouez Jillian L, Siodlak Magdalena, Tjugum Shelby, Rice John P, Fernandez Luis A
Pharmacy Department, UW Health, Madison, Wisconsin.
University of Wisconsin School of Pharmacy, Madison, Wisconsin.
Pharmacotherapy. 2018 Jul;38(7):758-768. doi: 10.1002/phar.2130. Epub 2018 Jul 1.
This article summarizes available literature regarding the utilization of probiotic and synbiotics in liver transplant (LTX) recipients, reviewing efficacy in both decreasing infectious complications and immunomodulation, as well as exploring safety concerns. Data suggest that the use of probiotics containing Lactobacillus spp, either alone or in combination with prebiotics (referred to as synbiotics), may be effective in reducing infectious complications after LTX, a major contributor to graft loss, hospital length of stay, and mortality. Literature evaluating the use of probiotics to induce tolerance, reduce rejection, and prevent damage associated with ischemia-reperfusion injury is limited to animal models but compelling, as it suggests the use of probiotics may augment deleterious immune-mediated processes in this population. While the benefits of probiotics should be weighed against potential risks, these concerns are largely theoretical in the LTX recipient, with the majority of evidence extrapolated from case reports in other immunosuppressed populations. Based on available literature, it may be prudent to avoid products containing Saccharomyces sp, as these were not used in the efficacy studies, and the majority of the adverse event reporting stems from the use of products containing this organism. Further evaluation of the safety and efficacy of probiotic therapy is warranted. Studies specifically designed to elucidate the optimal product and initiation scenario and delineate safety in this population are needed to allow expanded use of this inexpensive, relatively nontoxic, and potentially beneficial therapeutic option after LTX.
本文总结了关于肝移植（LTX）受者使用益生菌和合生元的现有文献，回顾了其在减少感染并发症和免疫调节方面的疗效，并探讨了安全性问题。数据表明，单独使用含乳酸杆菌属的益生菌或与益生元联合使用（称为合生元），可能有效降低肝移植后的感染并发症，而感染并发症是导致移植物丢失、住院时间和死亡率的主要因素。评估益生菌用于诱导耐受、减少排斥反应以及预防与缺血再灌注损伤相关损害的文献仅限于动物模型，但很有说服力，因为这表明使用益生菌可能会加剧该人群中有害的免疫介导过程。虽然应权衡益生菌的益处与潜在风险，但这些担忧在肝移植受者中大多只是理论上的，大多数证据是从其他免疫抑制人群的病例报告中推断出来的。根据现有文献，避免使用含有酿酒酵母属的产品可能较为谨慎，因为这些产品未用于疗效研究，且大多数不良事件报告都源于使用含有该微生物的产品。有必要对益生菌疗法的安全性和疗效进行进一步评估。需要专门设计的研究来阐明最佳产品和起始方案，并界定该人群中的安全性，以便在肝移植后扩大使用这种廉价、相对无毒且可能有益的治疗选择。
